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General NPI Number Information
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NPI Number | 1144771247
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Entity Type | Organization
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Legal Business Name | JAMES WILKES BRADHAM INC
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Dates
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Enumeration Date | 10/24/2016
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Last Update Date | 10/24/2016
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Provider Practice Location Address
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Address Line | 130 DESOTO AVE SUITE 10
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City | CLARKSDALE
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State | MS
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Zip | 38614-4439
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Country | US
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Telephone | 662-621-9898
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Fax |
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Provider Business Mailing Address
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Address Line | 130 DESOTO AVE SUITE 10
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City | CLARKSDALE
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State | MS
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Zip | 38614-4439
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Country | US
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Telephone | 662-621-9898
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAMES WILKES BRADHAM
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Credential |
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Telephone | 662-621-9898
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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