Provider Demographics
NPI:1992828867
Name:BONGIOVANNI, BRADLEY (ND)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:BONGIOVANNI
Suffix:
Gender:M
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3502 OLD MILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4458
Mailing Address - Country:US
Mailing Address - Phone:678-456-5022
Mailing Address - Fax:888-338-3634
Practice Address - Street 1:3502 OLD MILTON PKWY
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4458
Practice Address - Country:US
Practice Address - Phone:678-456-5022
Practice Address - Fax:888-338-3634
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR899175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath