Organization
WIREGRASS BEHAVIORAL SYSTEMS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BASCOM KYLE BRADSHAW DO (DIRECTOR)
(210) 454-3703
Entity
Organization
Contact information
Practice address
6501 US HIGHWAY 431 N, HEADLAND, AL 36345-5657
(334) 695-2253
Mailing address
1358 STATE HIGHWAY 134 E, HEADLAND, AL 36345-8517
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
DO.1388
AL
Other
Enumeration date
05/12/2015
Last updated
05/12/2015
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