Individual
BRADLEY DILLON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
2601 GETWELL RD STE 4, CORINTH, MS 38834-6762
(662) 643-4533
Mailing address
103 CAITLYN DR, SALTILLO, MS 38866-8103
(662) 574-7595
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
902456
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01155847
—
MS
Enumeration date
12/19/2017
Last updated
05/16/2019
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