Healthcare Provider Details

I. General information

NPI: 1922308360
Provider Name (Legal Business Name): JOY D BRADFORD RD, LDN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOY D STAFFORD RD, LDN

II. Dates (important events)

Enumeration Date: 11/02/2010
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 REGIONAL DR
PINEHURST NC
28374
US

IV. Provider business mailing address

205 PAGE RD
PINEHURST NC
28374-8749
US

V. Phone/Fax

Practice location:
  • Phone: 910-295-5511
  • Fax:
Mailing address:
  • Phone: 910-295-5511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License NumberL003732
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: