Healthcare Provider Details

I. General information

NPI: 1477750065
Provider Name (Legal Business Name): BRADLEY H ZAHN EDS,SLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5515 SHELBY OAKS DR
MEMPHIS TN
38134-7316
US

IV. Provider business mailing address

6370 PINEY RIVER RD
BARTLETT TN
38135-1167
US

V. Phone/Fax

Practice location:
  • Phone: 901-252-1282
  • Fax: 901-252-7680
Mailing address:
  • Phone: 901-335-3714
  • Fax: 901-252-7680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPE0000001572
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: