Provider Demographics
NPI:1831947894
Name:BRADY, ALAN JAMAL
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:JAMAL
Last Name:BRADY
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 1:1700 NORTHSIDE DR NW STE A72907
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2673
Mailing Address - Country:US
Mailing Address - Phone:404-449-3698
Mailing Address - Fax:
Practice Address - Street 1:308 HOLBROOK RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30082-4869
Practice Address - Country:US
Practice Address - Phone:404-449-3698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver