Provider Demographics
NPI:1528010246
Name:BRADY, MICHAEL N (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:N
Last Name:BRADY
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 1:320 MARGIE DR
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-7817
Mailing Address - Country:US
Mailing Address - Phone:478-953-0911
Mailing Address - Fax:478-953-0900
Practice Address - Street 1:320 MARGIE DR
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-7817
Practice Address - Country:US
Practice Address - Phone:478-953-0911
Practice Address - Fax:478-953-0900
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA033534207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00329356OtherMEDICARE RAILROAD #
GA000503676CMedicaid
GAP00329356OtherMEDICARE RAILROAD #
GA11SCGDVMedicare PIN