Individual
DR. BRADLEY J. G. LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
157 CLINIC AVE, STE 101, CARROLLTON, GA 30117-4413
(770) 333-2220
(678) 581-7180
Mailing address
531 ROSELANE ST NW STE 710, MARIETTA, GA 30060-6975
(678) 331-3297
(678) 581-7187
Taxonomy
Speciality
Code
Description
License number
State
207RH0003X
Hematology & Oncology Physician
Primary
054449
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009950455
—
AL
01
—
1194729582
NPI NUMBER
GA
05
—
184142314A
—
GA
05
—
184142314B
—
GA
05
—
184142314C
—
GA
Enumeration date
06/13/2005
Last updated
12/13/2017
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