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General NPI Number Information
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NPI Number | 1245235373
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Entity Type | Individual
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Provider Name | MILLARD BRADY THOMAS III MD
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Gender | Male
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Dates
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Enumeration Date | 06/16/2005
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Last Update Date | 05/03/2017
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Provider Practice Location Address
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Address Line | 132 W MILLER ST SUITE C
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City | ASHEBORO
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State | NC
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Zip | 27203-4774
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Country | US
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Telephone | 336-626-3202
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Fax | 336-521-4923
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Provider Business Mailing Address
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Address Line | PO BOX 5418
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City | ASHEBORO
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State | NC
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Zip | 27204-5418
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Country | US
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Telephone | 336-625-2333
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Fax | 336-625-5511
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 34480
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License Number State | NC
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