Elizabeth Sue Bradshaw-Livingston, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

003691 Issued in GA

Practice address

675 Seminole Ave NE Ste T03
Atlanta, GA 30307-3409

Phone

(404) 249-0520

NPI assigned

Jul 24, 2018

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

Credentials

Doctor of Philosophy

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.

• Samudra Psychological Services LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Atlanta, GA
  • NPI 1194202911
  NPD (past) Authorized official

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

{
    "created_epoch": "1532390400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532390400000",
    "number": "1962989780",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "316 SOMERLANE PL",
            "city": "AVONDALE ESTATES",
            "state": "GA",
            "postal_code": "300021221",
            "telephone_number": "269-352-7407"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 SEMINOLE AVE NE STE T03",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303073409",
            "telephone_number": "404-249-0520"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADSHAW-LIVINGSTON",
        "first_name": "ELIZABETH",
        "middle_name": "SUE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-07-24",
        "last_updated": "2018-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "003691",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robin Bradley
• Steven Bradley
• Tiara Bradley, MASSAGE THERAPIST
• Kimberly Straub Bradlyn, PA
• Stephen Bradlyn
• Carmen Bradshaw, FNP-BC
• Christine Cathryn Bradshaw, DO, MPH, MBA
• Courtney Bradshaw
• Abaigeal Cecilia Elizabeth Brady
• Charles Brady

• Psychologist in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2018; 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.