Provider Demographics
NPI:1134130156
Name:BRADSHAW, STEVEN MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:MARK
Last Name:BRADSHAW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:
Other - Last Name:BRADSHAW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1068
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30162-1068
Mailing Address - Country:US
Mailing Address - Phone:706-235-6539
Mailing Address - Fax:706-235-6541
Practice Address - Street 1:310 W 10TH ST NE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30165-2639
Practice Address - Country:US
Practice Address - Phone:706-235-6539
Practice Address - Fax:706-235-6541
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA045408207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000793537CMedicaid
GA16BBCFXMedicare ID - Type Unspecified