Provider Demographics
NPI:1023003431
Name:BIELTZ, JOHN BRADLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:BRADLEY
Last Name:BIELTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 720
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-0720
Mailing Address - Country:US
Mailing Address - Phone:706-597-9700
Mailing Address - Fax:706-597-0790
Practice Address - Street 1:510 MOUNT PLEASANT RD
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-8139
Practice Address - Country:US
Practice Address - Phone:706-597-9700
Practice Address - Fax:706-597-0790
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA038689207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA616528OtherBCBS
GA00623147AMedicaid
GA200038452OtherRR MEDICARE
GAE52097Medicare UPIN
GA00623147AMedicaid