Individual
DR. BRADFORD BOOTSTAYLOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
600 W PEACHTREE ST NW, SUITE 500, ATLANTA, GA 30308-3607
(404) 475-0816
(404) 875-7102
Mailing address
285 BOULEVARD NE STE 345A, ATLANTA, GA 30312-4205
(404) 618-6825
(404) 480-3876
Taxonomy
Speciality
Code
Description
License number
State
207VM0101X
Maternal & Fetal Medicine Physician
041733
GA
208VP0000X
Pain Medicine Physician
Primary
041733
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000702996F
—
GA
05
—
000702996G
—
GA
05
—
000702996H
—
GA
05
—
000702996J
—
GA
05
—
000702996K
—
GA
05
—
000702996Q
—
GA
05
—
000702996S
—
GA
05
—
000702996T
—
GA
05
—
000702996V
—
GA
Enumeration date
06/14/2006
Last updated
10/28/2022
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