Individual
LANIE ANN BRADFORD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
385 THOMPSON TOWN RD, COLQUITT, GA 39837-5231
(229) 416-8243
Mailing address
385 THOMPSON TOWN RD, COLQUITT, GA 39837-5231
(229) 416-8243
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
09/19/2022
Last updated
09/19/2022
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