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GORDON L BRADY DMD NPI 1619085396


NPI Information

NPI: 1619085396
Provider Name: GORDON L BRADY, DMD
Classification: Dentist - 1223S0112X
Entity Type: Individual

Specialization: Oral and Maxillofacial Surgery

PECOS Registration: Yes

Address:
1463 KLONDIKE RD
SUITE C
CONYERS, GA
ZIP 30094
Phone: (770) 483-9692
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Gordon L Brady, DMD is an oral and maxillofacial surgery dentist in Conyers, GA with 48 years of experience. The provider is an oral and maxillofacial surgery dentist specialized in the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. Gordon L Brady, DMD NPI is 1619085396. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

Education
Medical School: GEORGIA REGENTS UNIVERSITY COLLEGE OF DENTAL MEDICINE
Graduation Year:1976

The provider's business location address is:

1463 KLONDIKE RD
SUITE C
CONYERS, GA
ZIP 30094
Phone: (770) 483-9692

The NPI 1619085396 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA).

The enumeration date for this NPI number is 8/25/2006 and was last updated on 7/8/2007.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223S0112XDentistOral and Maxillofacial SurgeryDN008601GEORGIAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
11708MEDICARE ID-TYPE UNSPECIFIEDGEORGIAGROUP
2T86957MEDICARE UPIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.