Individual
DR. BRADLEY ALAN BERTRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1330 INTERSTATE PKWY, AUGUSTA, GA 30909-5625
(706) 651-2020
(706) 855-6674
Mailing address
1330 INTERSTATE PKWY, AUGUSTA, GA 30909-5625
(706) 651-2020
(706) 855-6674
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
030011
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000389958E
—
GA
01
—
18BDFMJ
PTAN
GA
01
—
1977325
CIGNA
—
01
—
4363115
AETNA
—
01
—
768090
BLUE CROSS OF GEORGIA
GA
Enumeration date
12/13/2006
Last updated
05/28/2015
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