Provider Demographics
NPI:1396144028
Name:BRADLEY, ASHLEY SPAKE (NP)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:SPAKE
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1682 MOUNT VERNON RD NW
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30656-4357
Mailing Address - Country:US
Mailing Address - Phone:404-414-2801
Mailing Address - Fax:
Practice Address - Street 1:1010 VILLAGE DR
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-6004
Practice Address - Country:US
Practice Address - Phone:706-534-6970
Practice Address - Fax:706-534-6983
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2024-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN213234163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse