Emaly Elizabeth Bradford, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

12758 Issued in GA

Practice address

1180 Resurgence Dr Ste 100
Watkinsville, GA 30677-7211

Phone

(706) 204-1694

NPI assigned

Dec 6, 2024

Sex

Female

Sole proprietor

No

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

Enrolled in GA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Georgia Skin Cancer and Aestheitic Dermatology, LLCGroup PAC ID 0244328649, 25 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

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 Skin Cancer & Aestheitic Dermatology, LLC

  • Dermatology Physician
  • Watkinsville, GA
  • NPI 1205026168
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1733443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733443200000",
    "number": "1235945916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1180 RESURGENCE DR STE 100",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777211",
            "telephone_number": "706-204-1694"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1180 RESURGENCE DR STE 100",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777211",
            "telephone_number": "706-204-1694"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADFORD",
        "first_name": "EMALY",
        "middle_name": "ELIZABETH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-12-06",
        "last_updated": "2024-12-06",
        "certification_date": "2024-12-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "12758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Eliza Janes Boswell, FNP-C
• Leslie Bottier, RBT
• Tamara Bowman, CCC-SLP
• Bowtie Hearing Aid Center LLC
• Michael Boyd, PA
• Ashley Spake Bradley, NP
• Emily J. Bradley, D.M.D.
• Abigail Brannen, SLP
• Courtney Brannen, FNP
• Brant Sandifer DMD LLC

• Physician Assistant in Watkinsville, GA
• Providers in Watkinsville, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2024; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.