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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 3 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.

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Identifiers

StateTypeNumberIssuer
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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