Provider Demographics
NPI:1700817160
Name:BRADLEY, LYNN KOENECKE (PA)
Entity Type:Individual
Prefix:MS
First Name:LYNN
Middle Name:KOENECKE
Last Name:BRADLEY
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Gender:F
Credentials:PA
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Mailing Address - Street 1:1047 SWAYING PINES TRCE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2784
Mailing Address - Country:US
Mailing Address - Phone:770-591-7963
Mailing Address - Fax:404-728-4838
Practice Address - Street 1:VA MEDICAL CENTER
Practice Address - Street 2:1670 CLAIRMONT ROAD
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-9819
Practice Address - Country:US
Practice Address - Phone:404-321-6111
Practice Address - Fax:404-728-4838
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical