Provider Demographics
NPI:1598746943
Name:CARDEN, BRADLEY LAMAR (MD)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:LAMAR
Last Name:CARDEN
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:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:FORTSON
Mailing Address - State:GA
Mailing Address - Zip Code:31808-0370
Mailing Address - Country:US
Mailing Address - Phone:706-494-3072
Mailing Address - Fax:334-664-0466
Practice Address - Street 1:4401 RIVERCHASE DR
Practice Address - Street 2:
Practice Address - City:PHENIX CITY
Practice Address - State:AL
Practice Address - Zip Code:36867-7483
Practice Address - Country:US
Practice Address - Phone:334-732-3000
Practice Address - Fax:334-732-3646
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017146207Q00000X
AL00007157207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000148222EMedicaid
AL009936825Medicaid
GA08BBQLVMedicare PIN
GA000148222EMedicaid
AL051517378Medicare PIN
E01148Medicare UPIN
AL009936825Medicaid