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General NPI Number Information
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NPI Number | 1841249489
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Entity Type | Individual
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Provider Name | BRADLEY MARTIN PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 10/17/2025
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Provider Practice Location Address
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Address Line | 815 HIGHWAY 51 N
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City | BROOKHAVEN
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State | MS
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Zip | 39601-2079
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Country | US
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Telephone | 601-554-7400
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Fax |
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Provider Business Mailing Address
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Address Line | 3688 VETERANS MEMORIAL DR STE 200
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City | HATTIESBURG
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State | MS
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Zip | 39401-8246
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Country | US
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Telephone | 601-554-7400
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA00053
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License Number State | MS
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