Individual
DR. THOMAS LANE BRADBURY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
59 EXECUTIVE PARK S, ATLANTA, GA 30329-2208
(404) 778-7188
(404) 778-7036
Mailing address
59 EXECUTIVE PARK S, ATLANTA, GA 30329-2208
(404) 778-7188
(404) 778-7036
Taxonomy
Speciality
Code
Description
License number
State
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
059130
GA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
200600296
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5904146
—
NC
Enumeration date
07/06/2006
Last updated
02/01/2015
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