Individual
BRADLEY F. SUMRALL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
255 BAPTIST BLVD, SUITE 401, COLUMBUS, MS 39705-2011
(662) 244-2288
(662) 244-2289
Mailing address
PO BOX 405827, ATLANTA, GA 30384-5827
(870) 934-5821
(870) 934-5384
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA00066
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04729081
—
MS
Enumeration date
06/16/2006
Last updated
10/15/2010
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