Individual
MS. TAJUANA B BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
698 DULUTH HWY STE 201, LAWRENCEVILLE, GA 30046-7648
(770) 822-0788
(770) 822-0326
Mailing address
1835 SAVOY DR, SUITE 300, ATLANTA, GA 30341-1072
(770) 822-0788
(770) 822-0326
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN148400
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
202I502094
MEDICARE PTAN
GA
05
—
215815240E
—
GA
05
—
215815240F
—
GA
Enumeration date
12/21/2009
Last updated
08/25/2020
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