Provider Demographics
NPI:1689832214
Name:BRADFORD, ANDREA CAROL (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:CAROL
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4280 BALL GROUND RD
Mailing Address - Street 2:
Mailing Address - City:BALL GROUND
Mailing Address - State:GA
Mailing Address - Zip Code:30107-4371
Mailing Address - Country:US
Mailing Address - Phone:770-294-1214
Mailing Address - Fax:770-737-3003
Practice Address - Street 1:4170 ASHFORD DUNWOODY RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30319-1442
Practice Address - Country:US
Practice Address - Phone:404-949-2845
Practice Address - Fax:770-737-3003
Is Sole Proprietor?:No
Enumeration Date:2008-05-30
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0268322084P0800X
NC2001000182084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry