Healthcare Provider Details

I. General information

NPI: 1255171096
Provider Name (Legal Business Name): BRADLEY MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 CHAMBLISS AVE NW
CLEVELAND TN
37311-3847
US

IV. Provider business mailing address

PO BOX 1900
DALTON GA
30722-1900
US

V. Phone/Fax

Practice location:
  • Phone: 423-728-1650
  • Fax:
Mailing address:
  • Phone: 423-728-1650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: RANDALL FOSTER
Title or Position: DIRECTOR, FINANCIAL SERVICES
Credential:
Phone: 706-272-6124