Provider Demographics
NPI:1003061789
Name:WILLIAMS, BRADLEY G (CRNA)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:G
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10824
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35202-0824
Mailing Address - Country:US
Mailing Address - Phone:888-245-5525
Mailing Address - Fax:717-653-8197
Practice Address - Street 1:600 S 3RD ST
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5304
Practice Address - Country:US
Practice Address - Phone:256-543-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-23
Last Update Date:2009-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-068691367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL515-95261OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL1003061789Medicaid
AL515-95261OtherBLUE CROSS BLUE SHIELD OF ALABAMA
AL510I430413Medicare PIN