Healthcare Provider Details

I. General information

NPI: 1922789049
Provider Name (Legal Business Name): BRADLEY MASON EADES MDIV, BCC, CT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 09/11/2025
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 BROOKSLANDING DR
HUNTSVILLE AL
35811-8699
US

IV. Provider business mailing address

120 BROOKSLANDING DR
HUNTSVILLE AL
35811-8699
US

V. Phone/Fax

Practice location:
  • Phone: 256-945-0879
  • Fax: 256-885-6769
Mailing address:
  • Phone: 256-945-0879
  • Fax: 256-885-6769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: