Provider Demographics
NPI:1174829386
Name:BRADFIELD, STACY HARRISON (SRNA)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:HARRISON
Last Name:BRADFIELD
Suffix:
Gender:F
Credentials:SRNA
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:
Other - Last Name:HARRISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:3390 PEACHTREE RD NE
Mailing Address - Street 2:STE 1500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-1157
Mailing Address - Country:US
Mailing Address - Phone:404-920-4950
Mailing Address - Fax:
Practice Address - Street 1:3870 MEDICAL PARK DR
Practice Address - Street 2:STE 110
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1110
Practice Address - Country:US
Practice Address - Phone:770-948-6824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-04
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCR109902367500000X
MDR179251367500000X
GARN170998367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered