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Individual

DR. BRADLEY C PHOENIX

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
2701 N. DECATUR RD, DECATUR, GA 30033-0000
(678) 514-1991
(678) 514-1992
Mailing address
PO BOX 551420, FORT LAUDERDALE, FL 33355-1420
(800) 243-3839
(954) 839-2569

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
059852
GA
207L00000X
Anesthesiology Physician
22087
WV

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
831955056A
GA
Enumeration date
08/05/2006
Last updated
04/10/2013
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