Jennifer Elaine Bradberry, ATC

Primary specialty

SpecialistTaxonomy code 174400000X

License

AT001336 Issued in GA

Practice address

6340 Sugarloaf Pkwy
Suite 375
Duluth, GA 30097-4333

Phone

(770) 814-2223

Fax

(770) 814-2232

NPI assigned

Feb 1, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Georgia Sports Medicine, LLC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • Duluth, GA
  • NPI 1710160601

  Single Specialty

  NPD (past)
• The Longstreet Clinic PC

  • Prosthetic/Orthotic Supplier
  • Gainesville, GA
  • NPI 1053422428

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1104964568",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3175 SUPERIOR DR",
            "city": "DACULA",
            "state": "GA",
            "postal_code": "300193417",
            "telephone_number": "404-401-5812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6340 SUGARLOAF PKWY",
            "address_2": "SUITE 375",
            "city": "DULUTH",
            "state": "GA",
            "postal_code": "300974333",
            "telephone_number": "770-814-2223",
            "fax_number": "770-814-2232"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADBERRY",
        "first_name": "JENNIFER",
        "middle_name": "ELAINE",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "GA",
            "license": "AT001336",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Divonia Boyd
• Laurilyn D Boyd, CNP
• Boyle and Toth Family Medicine, L.L.C.
• David Robert Braatz, M.S.
• Lasidra Brabson
• Del-Landria Bradley, SLP
• Rebecca Bradley
• Brainscience Recovery.Works
• Meghan Branche
• Stephanie Nicole Brangwin

• Specialist in Duluth, GA
• Providers in Duluth, GA by specialty
• Specialist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.