MEDICARE: ANDREA CAROL BRADFORD MD

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	2084P0800X	Psychiatry Physician	026832	GA
2	2084P0800X	Psychiatry Physician	200100018	NC

General Provider Information

NPI Number	:	1689832214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA CAROL BRADFORD MD

Provider Business Mailing Address
First Line	:	4280 BALL GROUND RD
Second Line	:
City	:	BALL GROUND
State	:	GA
Zip	:	30107-4371
Country	:	US
Telephone Number	:	770-294-1214
Fax Number	:	770-737-3003

Provider Business Practice Location Address
First Line	:	4170 ASHFORD DUNWOODY RD NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30319-1442
Country	:	US
Telephone Number	:	404-949-2845
Fax Number	:	770-737-3003

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

Provider Enumeration Date	:	05/30/2008
Last Update Date	:	08/01/2012

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