Provider Demographics
NPI:1477995256
Name:BRADAM, DANIEL G JR (CFA/CST, AS)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:G
Last Name:BRADAM
Suffix:JR
Gender:M
Credentials:CFA/CST, AS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9440 GOFF RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:TN
Mailing Address - Zip Code:38544-6900
Mailing Address - Country:US
Mailing Address - Phone:931-854-7560
Mailing Address - Fax:
Practice Address - Street 1:9440 GOFF RIDGE RD
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:TN
Practice Address - Zip Code:38544-6900
Practice Address - Country:US
Practice Address - Phone:931-854-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-23
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant