Individual provider · NPI-1

Jordan H Bradshaw, DO

Family Medicine · Rome, GA

NPI number1477249993
StatusActive
Last updated in NPPESOct 1, 2026

Details

NPI
1477249993
Entity type
Individual (NPI-1)
Name
Jordan H Bradshaw
Credential
DO
Sex
Male
Sole proprietor
No
Enumeration date
Apr 17, 2023
Certification date
Oct 1, 2026
Last updated
Oct 1, 2026

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine111625GAYes

Practice location

15 Riverbend Dr Sw
Rome, GA 30161-6005

Phone 706-291-0084 · Fax 706-291-1241

Mailing address

420 E 2nd Ave Ste 103
Rome, GA 30161-3210

Phone 706-509-3000

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