Provider Demographics
NPI:1265891634
Name:WHITE, BRADLEY MATTHEW (DO)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:MATTHEW
Last Name:WHITE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1551 JANMAR RD
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-5606
Mailing Address - Country:US
Mailing Address - Phone:678-344-8900
Mailing Address - Fax:678-666-5201
Practice Address - Street 1:2711 IRVIN WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-5405
Practice Address - Country:US
Practice Address - Phone:678-344-8900
Practice Address - Fax:678-666-5201
Is Sole Proprietor?:No
Enumeration Date:2016-02-15
Last Update Date:2025-09-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1051532085R0204X, 2085R0202X
FLOS148592085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology