Individual
PAUL S BRADLEY
Active
Individual
PAUL S BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
030016
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000353064K
—
GA
01
—
01259169
AMERIGROUP
GA
05
—
G30016
—
SC
01
—
P00630127
RR MEDICARE
GA
Enumeration date
06/03/2006
Last updated
09/24/2012
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