Healthcare Provider Details

I. General information

NPI: 1427477686
Provider Name (Legal Business Name): BRADLEY WILLS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 05/03/2024
Certification Date: 05/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 FRANKLIN ST SE
HUNTSVILLE AL
35801-4306
US

IV. Provider business mailing address

927 FRANKLIN ST SE
HUNTSVILLE AL
35801-4306
US

V. Phone/Fax

Practice location:
  • Phone: 256-539-2728
  • Fax:
Mailing address:
  • Phone: 256-539-2728
  • Fax: 256-539-2666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101266951
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number34816
License Number StateAL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number34816
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: