Provider Demographics
NPI:1164606018
Name:BRAGG, JULIAN ALEXANDER (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:ALEXANDER
Last Name:BRAGG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:285 BOULEVARD NE STE 610
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30312-4212
Mailing Address - Country:US
Mailing Address - Phone:404-653-0039
Mailing Address - Fax:404-653-0159
Practice Address - Street 1:285 BOULEVARD NE STE 610
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-4212
Practice Address - Country:US
Practice Address - Phone:404-653-0039
Practice Address - Fax:404-653-0159
Is Sole Proprietor?:No
Enumeration Date:2007-12-27
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA608012084N0400X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1407869407OtherPRACTICE NPI
GA60801OtherSTATE LICENSE
GAFB1357981OtherDEA, DR. BRAGG
GA651792740AMedicaid