Provider Demographics
NPI:1376882563
Name:BRADLEY, JERRY ALLEN JR (MD, EDD, MDIV)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:ALLEN
Last Name:BRADLEY
Suffix:JR
Gender:M
Credentials:MD, EDD, MDIV
Other - Prefix:
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Mailing Address - Street 1:PO BOX 746450
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6450
Mailing Address - Country:US
Mailing Address - Phone:866-401-3057
Mailing Address - Fax:318-868-6430
Practice Address - Street 1:575 STANTON RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36617-2344
Practice Address - Country:US
Practice Address - Phone:251-471-7207
Practice Address - Fax:251-471-7207
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ALMD.34716207QH0002X, 207QG0300X
KY54528390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine