# IMMUNE RECOVERY FOUNDATION LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1831128578
- **Authorized official:** S. EDWARD BRADFORD P.A. (OWNER)
- **Authorized official phone:** (770) 455-6100

## Contact information

- **Practice address:** 4646 N SHALLOWFORD RD, SUITE 200, ATLANTA, GA 30338-6304
- **Practice address phone:** (770) 455-6100
- **Practice address fax:** (727) 455-1999
- **Mailing address:** 4646 N SHALLOWFORD RD, SUITE 200, ATLANTA, GA 30338-6304
- **Mailing address phone:** (770) 455-6100
- **Mailing address fax:** (727) 455-1999

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | — | NULL | Yes |

## Other

- **Enumeration date:** 07/03/2006
- **Last updated:** 08/22/2020