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General NPI Number Information
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NPI Number | 1558994640
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Entity Type | Individual
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Provider Name | JAMES ALLEN BRADFIELD SR.
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Gender | Male
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Dates
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Enumeration Date | 02/17/2020
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Last Update Date | 02/17/2020
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Provider Practice Location Address
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Address Line | 203 COMMERCE AVE STE A
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City | LAGRANGE
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State | GA
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Zip | 30241-2358
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Country | US
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Telephone | 706-883-6178
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Fax | 706-885-0487
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Provider Business Mailing Address
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Address Line | 203 COMMERCE AVE STE A
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City | LAGRANGE
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State | GA
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Zip | 30241-2355
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Country | US
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Telephone | 706-883-6178
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Fax | 706-885-0487
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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 | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 14136
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1835P0018X
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Taxonomy Name | Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
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License Number | 021016
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License Number State | GA
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