Provider Demographics
NPI:1013483858
Name:TOMPSON, BRADLEY A
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:TOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 CAMANO WAY
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-8377
Mailing Address - Country:US
Mailing Address - Phone:470-488-0388
Mailing Address - Fax:470-488-0026
Practice Address - Street 1:794 MCDONOUGH RD STE 100
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:GA
Practice Address - Zip Code:30233-1572
Practice Address - Country:US
Practice Address - Phone:470-488-0388
Practice Address - Fax:470-488-0026
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)