MEDICARE: MS. HOLLIE K BRADLEY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	213383	GA

General Provider Information

NPI Number	:	1477074318
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. HOLLIE K BRADLEY NP

Provider Business Mailing Address
First Line	:	7701 WHITTLE RD
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31220-4009
Country	:	US
Telephone Number	:	404-788-3693
Fax Number	:

Provider Business Practice Location Address
First Line	:	4931 RIVERSIDE DR STE 200B
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31210-1157
Country	:	US
Telephone Number	:	800-277-7302
Fax Number	:	866-374-6663

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2017
Last Update Date	:	01/08/2024

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