Provider Demographics
NPI:1710311717
Name:MEDLING, BRAD (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:MEDLING
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11057
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38308-0117
Mailing Address - Country:US
Mailing Address - Phone:731-695-4897
Mailing Address - Fax:
Practice Address - Street 1:25 MAX LANE DR APT 305
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-2864
Practice Address - Country:US
Practice Address - Phone:731-300-7311
Practice Address - Fax:731-300-7319
Is Sole Proprietor?:No
Enumeration Date:2013-08-26
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37059207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine