Organization
IMMUNE RECOVERY INSTITUTE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SAMUEL EDWARD BRADFORD PAC (CEO)
(770) 455-6100
Entity
Organization
Contact information
Practice address
4536 CHAMBLEE DUNWOODY RD, STE 250, DUNWOODY, GA 30338-6200
(770) 455-6100
(770) 455-1999
Mailing address
4536 CHAMBLEE DUNWOODY RD, STE 250, DUNWOODY, GA 30338-6200
(770) 455-6100
(770) 455-1999
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
04/06/2010
Last updated
04/06/2010
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