MEDICARE: JUSTINIA BRADSBY

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	106E00000X	Assistant Behavior Analyst
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1558259960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUSTINIA BRADSBY

Provider Business Mailing Address
First Line	:	345 COUNTY LINE RD
Second Line	:
City	:	FAYETTEVILLE
State	:	GA
Zip	:	30215-4607
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1590 GROVE ST APT 30
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80204-2357
Country	:	US
Telephone Number	:	470-776-0232
Fax Number	:

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

Provider Enumeration Date	:	06/25/2025
Last Update Date	:	06/25/2025

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Directions to “ JUSTINIA BRADSBY ” Practice Location

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