MEDICARE: MRS. LAURA NUGENT BRADLEY PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	PA-807	AL

General Provider Information

NPI Number	:	1780950733
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LAURA NUGENT BRADLEY PA-C

Provider Business Mailing Address
First Line	:	800 ST. VINCENT'S DRIVE
Second Line	:	SUITE 700
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1630
Country	:	US
Telephone Number	:	205-933-8981
Fax Number	:	205-930-0746

Provider Business Practice Location Address
First Line	:	800 ST. VINCENT'S DRIVE
Second Line	:	SUITE 700
City	:	BIRMINGHAM
State	:	AL
Zip	:	35205-1630
Country	:	US
Telephone Number	:	205-933-8981
Fax Number	:	205-930-0746

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2012
Last Update Date	:	10/10/2019

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