Provider Demographics
NPI:1649317017
Name:DUPLANTIER, BRADLEY M (MD)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:M
Last Name:DUPLANTIER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3374 OLD PLANTATION RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327-2424
Mailing Address - Country:US
Mailing Address - Phone:770-690-8872
Mailing Address - Fax:
Practice Address - Street 1:531 ROSELANE ST NW
Practice Address - Street 2:SUITE 750
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-6913
Practice Address - Country:US
Practice Address - Phone:770-794-0477
Practice Address - Fax:770-794-3108
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031589207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000389991BMedicaid
GA050049329OtherRAILROAD MEDICARE
GA050049329OtherRAILROAD MEDICARE
GAB61974Medicare UPIN