Individual
BRADFORD JAMAL KENNEBREW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PTA
Contact information
Practice address
1227 ROCKBRIDGE RD STE 402, STONE MOUNTAIN, GA 30087-3006
(770) 925-9210
Mailing address
413 OCEAN AVE, COLUMBUS, GA 31907-6067
(706) 325-3988
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA003995
GA
Other
Enumeration date
07/27/2022
Last updated
08/29/2022
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