| Doctor Name: | MR. BOBBY JOEL TREADWELL |
| NPI Number: | 1033483458 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 5730 |
| Business Practice Address: | 4550 Cobb Parkway North Nw Suite 309b Acworth, GA - 301014180 |
| Business Phone Number: | 7709176795 |
| Business Fax Number: | 7705299077 |
| Mailing Address: | 4550 Cobb Parkway North Nw, Suite 309b ACWORTH |
| State: | GA |
| Postal Code: | 301014180 |
| Phone Number: | 7709176795 |
| Fax Number: | 7705299077 |
| NPI Enumeration Date: | 03/02/2012 |
| NPI Last Update Date: | 10/06/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AS0400X |
| License Number: | 5730 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Surgical |
| Taxonomy Definition: | |