Individual
MR. BRADLEY MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
815 HIGHWAY 51 N, BROOKHAVEN, MS 39601-2079
(601) 554-7400
Mailing address
3688 VETERANS MEMORIAL DR STE 200, HATTIESBURG, MS 39401-8246
(601) 554-7400
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA00053
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06974850
—
MS
Enumeration date
05/10/2006
Last updated
10/17/2025
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