Bradshaw, Mark
Bradshaw, Mark is an individual health care provider with primary practice located at 1255 Highway 54 W , Fayetteville GA 30214. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Internal Medicine, Allopathic & Osteopathic Physicians / Hospitalist. Allopathic & Osteopathic Physicians / Hospitalist is his primary health care specialty. Bradshaw, Mark can be contacted via phone (770) 719-7000.Contact Information
Primary practice address
1255 Highway 54 W
Fayetteville GA 30214
Phone: (770) 719-7000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Internal Medicine | 207R00000X | 003457 | Georgia |
| Allopathic & Osteopathic Physicians / Hospitalist | 208M00000X | 066574 | Georgia |
Profile Details
| NPI number | 1316107428 |
|---|---|
| LBN Legal business name | Bradshaw, Mark |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 11th, 2008 |
| Last updated | Jun 11th, 2018 - about 6 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 | 1316107428 | NPPES |
| Georgia | MEDICAID | 003112987D |
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