Basic Information
| Provider Information | |||||||||
| NPI: | 1972506590 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AUFFARTH | ||||||||
| FirstName: | BRADLEY | ||||||||
| MiddleName: | ROBERT | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 658 | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305030658 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707181122 | ||||||||
| FaxNumber: | 7705357445 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 JESSE JEWELL PKWY SE | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 305013834 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7705362323 | ||||||||
| FaxNumber: | 7705364947 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/27/2005 | ||||||||
| LastUpdateDate: | 02/26/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 044398 | GA | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 000775189C | 05 | GA | MEDICAID | 000775189D | 01 | GA | PEACH STATE | OTHER | 000775189O | 05 | GA | MEDICAID | 01053251 | 01 | GA | AMERIGROUP | OTHER | 52636812 | 01 | GA | BCBS | OTHER | 571688 | 01 | GA | COVENTRY | OTHER | P00416162 | 01 | GA | MEDICARE RAILROAD | OTHER | 1771991 | 01 | GA | UHC | OTHER | 000775189D | 05 | GA | MEDICAID | 000775189F | 05 | GA | MEDICAID | 000775189E | 05 | GA | MEDICAID | 34602 | 01 | GA | WELLCARE | OTHER | 000775189C | 01 | GA | PEACH STATE | OTHER | 1690000 | 01 | GA | CIGNA | OTHER |