Bootstaylor, Bradford
Bootstaylor, Bradford is an sole proprietor health care provider with primary practice located at 600 W Peachtree St Nw Suite 500, Atlanta GA 30308-3607. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Pain Medicine, Allopathic & Osteopathic Physicians / Maternal & Fetal Medicine. Allopathic & Osteopathic Physicians / Pain Medicine is his primary health care specialty. Bootstaylor, Bradford can be contacted via phone (404) 475-0816.Contact Information
Primary practice address
600 W Peachtree St Nw Suite 500
Atlanta GA 30308-3607
Phone: (404) 475-0816
Fax: (404) 875-7102
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Allopathic & Osteopathic Physicians / Pain Medicine | 208VP0000X | 041733 | Georgia |
Allopathic & Osteopathic Physicians / Maternal & Fetal Medicine | 207VM0101X | 041733 | Georgia |
Profile Details
NPI number | 1497798854 |
---|---|
LBN Legal business name | Bootstaylor, Bradford |
Credentials | Doctor of Medicine (MD) |
Entity | Individual |
Sole proprietor 1 | Yes |
Enumeration date | Jun 14th, 2006 |
Last updated | Oct 28th, 2022 - about 2 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1497798854 | NPPES |
Georgia | MEDICAID | 000702996H | |
Georgia | MEDICAID | 000702996Q | |
Georgia | MEDICAID | 000702996T | |
Georgia | MEDICAID | 000702996G | |
Georgia | MEDICAID | 000702996J | |
Georgia | MEDICAID | 000702996K | |
Georgia | MEDICAID | 000702996V | |
Georgia | MEDICAID | 000702996F | |
Georgia | MEDICAID | 000702996S |
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