Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 25481 | NC |
N | 208D00000X | General Practice Physician | 25481 | NC |
NPI | 1033197645 |
---|---|
Provider Name | Dr. George Lee Bradley |
First Address | Shelby, NC 28150-6184 |
Second Address | Shelby, NC 28150-6184 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/01/2006 |
Last Update Date | 28/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8917497 | (05) | NC |
C81331 | (02) |