Individual
BRADLEY EARNEST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PT
Contact information
Practice address
330 RONNELL RD BLDG 300, CANTON, GA 30115-8636
(404) 308-0817
Mailing address
1773 VISTA TRCE, DECATUR, GA 30033-1143
(404) 308-0817
Taxonomy
Speciality
Code
Description
License number
State
2251S0007X
Sports Physical Therapist
Primary
PT015872
GA
Other
Enumeration date
12/11/2023
Last updated
12/11/2023
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