Provider Demographics
NPI:1346720737
Name:BRADLEY, DONNA MARIE (CERTIFIED HAIR LOSS)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:MARIE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:CERTIFIED HAIR LOSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3995 DOWLING DR
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-1488
Mailing Address - Country:US
Mailing Address - Phone:706-394-9393
Mailing Address - Fax:877-635-1839
Practice Address - Street 1:3995 DOWLING DR
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-1488
Practice Address - Country:US
Practice Address - Phone:706-394-9393
Practice Address - Fax:877-635-1839
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-15
Last Update Date:2018-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management