Provider Demographics
NPI:1225074883
Name:BRADLEY, CATHERINE (MSN RN CS FNP DNP)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MSN RN CS FNP DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:PO BOX 116336
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368-6336
Mailing Address - Country:US
Mailing Address - Phone:912-352-8346
Mailing Address - Fax:912-355-1414
Practice Address - Street 1:4750 WATERS AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404
Practice Address - Country:US
Practice Address - Phone:912-350-5961
Practice Address - Fax:912-350-5942
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-21
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN093726363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0215Medicaid
GA000807815UMedicaid
GA000807815VMedicaid
GA000807815DMedicaid
GA50BBDWKMedicare PIN
GAP00732306Medicare PIN
GA00807815AMedicaid
GA202I509261Medicare PIN