Healthcare Provider Details

I. General information

NPI: 1760394373
Provider Name (Legal Business Name): WILLIAM ZACHARY BRADSHAW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 FORT LOUDON MEDICAL CENTER DR
LENOIR CITY TN
37772-5673
US

IV. Provider business mailing address

116 W ELDERBERRY ST
OAK RIDGE TN
37830-2515
US

V. Phone/Fax

Practice location:
  • Phone: 865-271-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: