Provider Demographics
NPI:1912286154
Name:BRADBERRY, JOHN FREEMAN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:FREEMAN
Last Name:BRADBERRY
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Gender:M
Credentials:MD
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Mailing Address - Street 1:290 COUNTRY CLUB DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9069
Mailing Address - Country:US
Mailing Address - Phone:678-284-6300
Mailing Address - Fax:678-284-6282
Practice Address - Street 1:6385 MCGINNIS FERRY RD
Practice Address - Street 2:SUITE 202
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30005-3621
Practice Address - Country:US
Practice Address - Phone:770-302-6767
Practice Address - Fax:678-284-6292
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-05
Last Update Date:2023-11-27
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Provider Licenses
StateLicense IDTaxonomies
GA068118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20208I6847Medicare PIN