Individual
BRADLEY ALLEN IRVIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4185 WILLOW WAY, MORRISTOWN, TN 37814-1611
(423) 248-4972
Mailing address
4185 WILLOW WAY, MORRISTOWN, TN 37814-1611
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3029
SC
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3749PA
—
SC
Enumeration date
12/21/2017
Last updated
06/14/2023
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