Individual
PAUL S BRADLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
340 EISENHOWER DRIVE, SUITE 1200, SAVANNAH, GA 31406
(912) 443-4200
(912) 355-8124
Mailing address
210 EAST DERENNE AVENUE, SAVANNAH, GA 31405
(912) 644-5300
(912) 644-5260
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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