Healthcare Provider Details

I. General information

NPI: 1245791656
Provider Name (Legal Business Name): HENRY CHASE BRADFORD IV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 04/07/2026
Certification Date: 04/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 THE PKWY STE L
GREER SC
29650-5205
US

IV. Provider business mailing address

8229 NEW CUT RD
CAMPOBELLO SC
29322-8733
US

V. Phone/Fax

Practice location:
  • Phone: 508-985-8805
  • Fax:
Mailing address:
  • Phone: 508-985-8805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number156562
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: