Individual
DR. BRADLEY MATTHEW FARROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012381
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100916
AVESIS MEDICAID
GA
01
—
1516786
TENNCARE
TN
05
—
1516786
—
TN
05
—
605327619A
—
GA
01
—
9183408
DORAL MEDICAID
GA
Enumeration date
11/30/2006
Last updated
04/15/2010
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