1114990140 NPI number — TONYA ELROD BRADLEY MD

Table of content: TONYA ELROD BRADLEY MD (NPI 1114990140)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114990140 NPI number — TONYA ELROD BRADLEY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRADLEY
Provider First Name:
TONYA
Provider Middle Name:
ELROD
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114990140
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2353 BENT CREEK RD STE 110
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUBURN
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36830-6482
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-887-8707
Provider Business Mailing Address Fax Number:
334-887-8707

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2353 BENT CREEK RD
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
AUBURN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36830-6482
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-887-8707
Provider Business Practice Location Address Fax Number:
334-887-8706
Provider Enumeration Date:
02/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  23526 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 051507393 . This is a "BLUE CROSS BLUE SHIELD AL" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 051507393 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com