Individual
DR. BRADLEY MATTHEW FARROW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4720 TRADERS WAY, SUITE 300, THOMPSONS STATION, TN 37179-5366
(615) 595-1559
(615) 595-9945
Mailing address
4720 TRADERS WAY, SUITE 300, THOMPSONS STATION, TN 37179-5366
(615) 595-1559
(615) 595-9945
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
DN012381
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100916
AVESIS MEDICAID
GA
01
—
1516786
TENNCARE
TN
05
—
1516786
—
TN
05
—
605327619A
—
GA
01
—
9183408
DORAL MEDICAID
GA
Enumeration date
11/30/2006
Last updated
04/15/2010
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