Individual
LISA ELAINE BRADY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.A.. P.P.
Contact information
Practice address
743 E ANN ST, VALDOSTA, GA 31601-4114
(401) 954-1535
Mailing address
PO BOX 5925, VALDOSTA, GA 31603-5925
(401) 954-1538
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
GA
Other
Enumeration date
10/10/2019
Last updated
10/10/2019
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