Individual
SAMUEL W BRADBERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1020 REELFOOT AVE, UNION CITY, TN 38261
(731) 885-5131
(731) 885-5335
Mailing address
PO BOX 405827, ATLANTA, GA 30384-5827
(870) 934-5871
(870) 934-5850
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
14195
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080091652
RAILROAD MEDICARE
TN
05
—
3002040
—
TN
Enumeration date
01/18/2006
Last updated
03/02/2012
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