Provider Demographics
NPI:1710221841
Name:BRADLEY, DAVID BRANDON (PA-C)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRANDON
Last Name:BRADLEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 PINE STREET
Mailing Address - Street 2:SUITE 750
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201
Mailing Address - Country:US
Mailing Address - Phone:478-633-1458
Mailing Address - Fax:478-633-5025
Practice Address - Street 1:840 PINE ST STE 750
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7528
Practice Address - Country:US
Practice Address - Phone:478-633-1458
Practice Address - Fax:478-633-5025
Is Sole Proprietor?:No
Enumeration Date:2012-11-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant