Provider Demographics
NPI:1225549967
Name:MILAM, BRADLEY (AGACNP)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:MILAM
Suffix:
Gender:M
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3413 N FOUNTAINCREST DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-5623
Mailing Address - Country:US
Mailing Address - Phone:865-322-2656
Mailing Address - Fax:
Practice Address - Street 1:1940 ALCOA HWY STE E210
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-2264
Practice Address - Country:US
Practice Address - Phone:865-524-7471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-21
Last Update Date:2017-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23404363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine