Provider Demographics
NPI:1861424509
Name:ZAGOL, BRADLEY RICHARD (MD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:RICHARD
Last Name:ZAGOL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1499 WALTON WAY, SUITE 1400
Mailing Address - Street 2:ATTN: DRAIFORD
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901
Mailing Address - Country:US
Mailing Address - Phone:706-828-8401
Mailing Address - Fax:706-722-7235
Practice Address - Street 1:1120 15TH SREET DEPARTMENT OF SURGERY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30912-2300
Practice Address - Country:US
Practice Address - Phone:706-721-4686
Practice Address - Fax:706-721-6828
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2014-00014208600000X
GA079033208600000X
OH35095068208600000X
VA0101236790208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA079033OtherGA LICENSE
GA079033OtherGA LICENSE