Provider Demographics
NPI:1992878045
Name:MCALISTER, BRADWELL RUSTIN (MD)
Entity type:Individual
Prefix:DR
First Name:BRADWELL
Middle Name:RUSTIN
Last Name:MCALISTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1010 VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:WATKINSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30677-6004
Mailing Address - Country:US
Mailing Address - Phone:706-769-0000
Mailing Address - Fax:706-769-0320
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:706-769-0000
Practice Address - Fax:706-769-0320
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA040480207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA08BDMZJMedicare PIN