Provider Demographics
NPI:1346385952
Name:YEARGIN, BRADLEY EUGENE (ATC)
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:EUGENE
Last Name:YEARGIN
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 HARDEN STREET EXT
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29203-6842
Mailing Address - Country:US
Mailing Address - Phone:803-606-3067
Mailing Address - Fax:
Practice Address - Street 1:3250 HARDEN STREET EXT
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6842
Practice Address - Country:US
Practice Address - Phone:803-606-3067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0002942255A2300X
SC13582255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer