Provider Demographics
NPI:1477074318
Name:BRADLEY, HOLLIE K (NP)
Entity Type:Individual
Prefix:MS
First Name:HOLLIE
Middle Name:K
Last Name:BRADLEY
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 1:7701 WHITTLE RD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31220-4009
Mailing Address - Country:US
Mailing Address - Phone:404-788-3693
Mailing Address - Fax:
Practice Address - Street 1:4931 RIVERSIDE DR STE 200B
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1157
Practice Address - Country:US
Practice Address - Phone:800-277-7302
Practice Address - Fax:866-374-6663
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA213383363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily