Provider Demographics
NPI:1033197645
Name:BRADLEY, GEORGE LEE (DO)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LEE
Last Name:BRADLEY
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 1:615 S DEKALB ST
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-6184
Mailing Address - Country:US
Mailing Address - Phone:704-480-1882
Mailing Address - Fax:704-480-1832
Practice Address - Street 1:615 S DEKALB ST
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-6184
Practice Address - Country:US
Practice Address - Phone:704-480-1882
Practice Address - Fax:704-480-1832
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25481207Q00000X, 208D00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8917497Medicaid
C81331Medicare UPIN
NC8917497Medicaid