MEDICARE: DR. BRADFORD BOOTSTAYLOR M.D.

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	208VP0000X	Pain Medicine Physician	041733	GA
2	207VM0101X	Maternal & Fetal Medicine Physician	041733	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497798854
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRADFORD BOOTSTAYLOR M.D.

Provider Business Mailing Address
First Line	:	285 BOULEVARD NE STE 345A
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30312-4205
Country	:	US
Telephone Number	:	404-618-6825
Fax Number	:	404-480-3876

Provider Business Practice Location Address
First Line	:	600 W PEACHTREE ST NW
Second Line	:	SUITE 500
City	:	ATLANTA
State	:	GA
Zip	:	30308-3607
Country	:	US
Telephone Number	:	404-475-0816
Fax Number	:	404-875-7102

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

Provider Enumeration Date	:	06/14/2006
Last Update Date	:	10/28/2022

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Directions to “ DR. BRADFORD BOOTSTAYLOR M.D.” Practice Location

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