Mary Magdalena Bradley, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN098614 Issued in GA

Practice address

2022 Windward LN Ste B2
Gainesville, GA 30501-7418

Phone

(770) 415-4430

Fax

(678) 717-0535

NPI assigned

Apr 14, 2017

Last updated

Oct 11, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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  • NPI 1922116219
  NPD

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

{
    "created_epoch": "1492128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1174057335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4144 CHATHAM CREST LN",
            "city": "BUFORD",
            "state": "GA",
            "postal_code": "305184916",
            "telephone_number": "770-415-4430",
            "fax_number": "678-717-0535"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2022 WINDWARD LN STE B2",
            "city": "GAINESVILLE",
            "state": "GA",
            "postal_code": "305017418",
            "telephone_number": "770-415-4430",
            "fax_number": "678-717-0535"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADLEY",
        "first_name": "MARY",
        "middle_name": "MAGDALENA",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-14",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "RN9410595",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN9410595",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN098614",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• William Bradley Boyd, MD
• Daniel Boylan, LPC
• Bracit
• Robin Braden, ACNP-BC
• Kelsey Bradford, AGACNP
• Wilmer D Bradley
• Ashlyn Bradshaw
• Shelia H Bradshaw, AGACNP-BC, DNP
• Evan Keith Brady, M.D.
• Vanessa Callahan Bragger, LMT

• Family Nurse Practitioner in Gainesville, GA
• Providers in Gainesville, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.