Individual
DR. JOHN EARL BRAGG JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3555 HARDEN STREET EXT STE 141, COLUMBIA, SC 29203-6894
(803) 434-4300
(803) 434-4277
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 293-7320
(803) 293-7330
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
21102
SC
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
21102
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
211023
—
SC
Enumeration date
03/31/2006
Last updated
04/16/2018
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