Healthcare Provider Details

I. General information

NPI: 1669490280
Provider Name (Legal Business Name): BRADLEY JAMES YOUNT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 W 5TH ST
GREENVILLE NC
27834-7813
US

IV. Provider business mailing address

2577 WEST FIFTH STREET
GREENVILLE NC
27834
US

V. Phone/Fax

Practice location:
  • Phone: 252-830-3426
  • Fax: 252-830-8585
Mailing address:
  • Phone: 252-830-3426
  • Fax: 252-830-8585

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number102901
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: