Individual
DR. CHARLES SHANNON BRADFORD JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1110 W PEACHTREE ST NW STE 1100, ATLANTA, GA 30309-3609
(404) 892-2131
(404) 215-9222
Mailing address
1110 W PEACHTREE ST NW STE 1100, ATLANTA, GA 30309-3609
(404) 892-2131
(404) 215-9222
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
070347
GA
207R00000X
Internal Medicine Physician
ME123871
FL
208M00000X
Hospitalist Physician
070347
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
003136131A
—
GA
05
—
014816300
—
FL
05
—
GA1558
—
SC
01
—
P01207903
RAILROAD MEDICARE
GA
01
—
P01476268
RAILROAD MEDICARE
FL
Enumeration date
05/04/2010
Last updated
07/25/2024
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