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General NPI Number Information
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NPI Number | 1215249131
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Entity Type | Individual
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Provider Name | BRADLEY NOEL GREENHAW M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/08/2010
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Last Update Date | 05/19/2015
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Provider Practice Location Address
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Address Line | 516 PEGRAM DR
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City | TUPELO
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State | MS
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Zip | 38801-6347
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Country | US
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Telephone | 662-844-6272
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Fax | 662-844-1603
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Provider Business Mailing Address
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Address Line | 516 PEGRAM DR
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City | TUPELO
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State | MS
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Zip | 38801-6347
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Country | US
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Telephone | 662-844-6272
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Fax | 662-844-1603
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 23810
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 207ND0101X
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Taxonomy Name | MOHS-Micrographic Surgery Physician
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License Number | 23810
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 23810
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License Number State | MS
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