Organization
IMMUNE RECOVERY FOUNDATION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
S. EDWARD BRADFORD P.A. (OWNER)
(770) 455-6100
Entity
Organization
Contact information
Practice address
4646 N SHALLOWFORD RD, SUITE 200, ATLANTA, GA 30338-6304
(770) 455-6100
(727) 455-1999
Mailing address
4646 N SHALLOWFORD RD, SUITE 200, ATLANTA, GA 30338-6304
(770) 455-6100
(727) 455-1999
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
—
—
Other
Enumeration date
07/03/2006
Last updated
08/22/2020
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