Provider Demographics
NPI:1538359831
Name:BRADLEY-POLK OB/GYN SERVICES P.C.
Entity type:Organization
Organization Name:BRADLEY-POLK OB/GYN SERVICES P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:CHAMBERS
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:423-476-4506
Mailing Address - Street 1:55 25TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3830
Mailing Address - Country:US
Mailing Address - Phone:423-476-4506
Mailing Address - Fax:423-478-2154
Practice Address - Street 1:55 25TH ST NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3830
Practice Address - Country:US
Practice Address - Phone:423-476-4506
Practice Address - Fax:423-478-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD6506174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty