James Randall Bradberry Jr., ATC, LAT

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT001398 Issued in GA

Practice address

2400 Highway 42 N
McDonough, GA 30253-4738

Phone

(404) 569-2463

NPI assigned

Sep 7, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1157587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1201737600000",
    "number": "1891899290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 DARWISH DR",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302523655",
            "telephone_number": "678-272-7814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2400 HIGHWAY 42 N",
            "city": "MCDONOUGH",
            "state": "GA",
            "postal_code": "302534738",
            "telephone_number": "404-569-2463"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADBERRY",
        "first_name": "JAMES",
        "middle_name": "RANDALL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "ATC, LAT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-07",
        "last_updated": "2008-01-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT001398",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Matthew Brea

• Athletic Trainer in McDonough, GA
• Providers in McDonough, GA by specialty
• Athletic Trainer in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; 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.