Provider Demographics
NPI:1134225618
Name:PIZZA, BRADFORD J (DC)
Entity type:Individual
Prefix:DR
First Name:BRADFORD
Middle Name:J
Last Name:PIZZA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3284 DOGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1158
Mailing Address - Country:US
Mailing Address - Phone:404-761-6200
Mailing Address - Fax:404-761-0825
Practice Address - Street 1:3284 DOGWOOD DR
Practice Address - Street 2:
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1158
Practice Address - Country:US
Practice Address - Phone:404-761-6200
Practice Address - Fax:404-761-0825
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR002138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00300704AMedicaid
GA350051350OtherRAILROAD MEDICARE
GA935698OtherBLUE CROSS BLUE SHIELD
GA158550800OtherDEPARTMENT OF LABOR
GA0004549922OtherAETNA
GA35ZCGBTMedicare ID - Type UnspecifiedMEDICARE