Provider Demographics
NPI:1922015452
Name:BRADFORD, TERESA MICHELE (MD)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MICHELE
Last Name:BRADFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TERESA
Other - Middle Name:MICHELE
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 2239
Mailing Address - Street 2:
Mailing Address - City:BLAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30514-2239
Mailing Address - Country:US
Mailing Address - Phone:706-745-2229
Mailing Address - Fax:706-745-0836
Practice Address - Street 1:63 PLEASANT HILL RD
Practice Address - Street 2:
Practice Address - City:BLAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30512-2291
Practice Address - Country:US
Practice Address - Phone:706-745-2229
Practice Address - Fax:706-745-0836
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058650207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5906394Medicaid
GA971476565BMedicaid
GA08CBCPBMedicare PIN
I34579Medicare UPIN