Healthcare Provider Details

I. General information

NPI: 1801220926
Provider Name (Legal Business Name): BRADLEY THOMPSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8295 TOURNAMENT DR 150
MEMPHIS TN
38125-8906
US

IV. Provider business mailing address

8295 TOURNAMENT DR 150
MEMPHIS TN
38125-8906
US

V. Phone/Fax

Practice location:
  • Phone: 866-563-7772
  • Fax: 901-255-0758
Mailing address:
  • Phone: 866-563-7772
  • Fax: 901-255-0758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: