Provider Demographics
NPI:1316289028
Name:BRADLEY, JOANNE S
Entity type:Individual
Prefix:MRS
First Name:JOANNE
Middle Name:S
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 BETHELVIEW RD
Mailing Address - Street 2:SUITE 110-442
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-9475
Mailing Address - Country:US
Mailing Address - Phone:404-617-6483
Mailing Address - Fax:888-404-9855
Practice Address - Street 1:2300 BETHELVIEW RD
Practice Address - Street 2:SUITE 110-442
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-9475
Practice Address - Country:US
Practice Address - Phone:404-617-6483
Practice Address - Fax:888-404-9855
Is Sole Proprietor?:No
Enumeration Date:2013-03-20
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAL01300028171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications