Provider Demographics
NPI:1740951433
Name:DONNAUD, BRADFORD P (LMT)
Entity type:Individual
Prefix:
First Name:BRADFORD
Middle Name:P
Last Name:DONNAUD
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1423 MARTIN NASH RD SW
Mailing Address - Street 2:
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-1944
Mailing Address - Country:US
Mailing Address - Phone:678-458-7899
Mailing Address - Fax:
Practice Address - Street 1:1423 MARTIN NASH RD SW
Practice Address - Street 2:
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-1944
Practice Address - Country:US
Practice Address - Phone:678-458-7899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-23
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMA000091225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1752OtherNCBTMB CERTIFIED CONTINUING EDUCATION PROVIDER #