Provider Demographics
NPI:1407284532
Name:BRADFORD FAMILY HEALTHCARE PC
Entity Type:Organization
Organization Name:BRADFORD FAMILY HEALTHCARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:BRADFORD
Authorized Official - Suffix:IV
Authorized Official - Credentials:MD
Authorized Official - Phone:256-647-3276
Mailing Address - Street 1:508 HARLEY ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:SCOTTSBORO
Mailing Address - State:AL
Mailing Address - Zip Code:35768-4294
Mailing Address - Country:US
Mailing Address - Phone:256-259-6054
Mailing Address - Fax:256-259-5206
Practice Address - Street 1:508 HARLEY ST
Practice Address - Street 2:SUITE D
Practice Address - City:SCOTTSBORO
Practice Address - State:AL
Practice Address - Zip Code:35768-4294
Practice Address - Country:US
Practice Address - Phone:256-259-6054
Practice Address - Fax:256-259-5206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-29
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00026295261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service