Provider Demographics
NPI:1518317569
Name:CAGLE, BRADLEY AARON (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:AARON
Last Name:CAGLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 N BROAD ST NE STE 120
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-5202
Mailing Address - Country:US
Mailing Address - Phone:706-291-2661
Mailing Address - Fax:
Practice Address - Street 1:901 N BROAD ST NE STE 120
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-5202
Practice Address - Country:US
Practice Address - Phone:706-291-2661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2021-008162085B0100X
SCLL35909208D00000X
GA905272085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice