Provider Demographics
NPI:1326120007
Name:BRADSHAW, VIRGINIA R (NP)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
Middle Name:R
Last Name:BRADSHAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:THOMSON
Mailing Address - State:GA
Mailing Address - Zip Code:30824-0266
Mailing Address - Country:US
Mailing Address - Phone:706-595-1740
Mailing Address - Fax:706-595-8503
Practice Address - Street 1:307 GREENWAY ST
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-2721
Practice Address - Country:US
Practice Address - Phone:706-595-1740
Practice Address - Fax:706-595-8503
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN069020363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics