Provider Demographics
NPI:1407036585
Name:CARR, BRADLEY EARNEST (NP)
Entity Type:Individual
Prefix:MR
First Name:BRADLEY
Middle Name:EARNEST
Last Name:CARR
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1705
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30903-1705
Mailing Address - Country:US
Mailing Address - Phone:706-774-7263
Mailing Address - Fax:706-774-7230
Practice Address - Street 1:1348 WALTON WAY STE 5700
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-5110
Practice Address - Country:US
Practice Address - Phone:706-774-7022
Practice Address - Fax:706-774-7023
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
247200000X
GARN238860363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other