Healthcare Provider Details

I. General information

NPI: 1538138391
Provider Name (Legal Business Name): WILLIAM BRAD CASTLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 03/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6250 OLD CANTON RD SUITE 100
JACKSON MS
39211-2946
US

IV. Provider business mailing address

965 RIDGE LAKE BLVD STE 103
MEMPHIS TN
38120-9446
US

V. Phone/Fax

Practice location:
  • Phone: 601-957-1015
  • Fax: 601-956-9721
Mailing address:
  • Phone: 901-227-3255
  • Fax: 901-227-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17650
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: