Provider Demographics
NPI:1790095222
Name:NUNLEY, BRAD DAVID (IDMT)
Entity Type:Individual
Prefix:MR
First Name:BRAD
Middle Name:DAVID
Last Name:NUNLEY
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1339 SPRING VALLEY DR NE
Mailing Address - Street 2:
Mailing Address - City:ARAB
Mailing Address - State:AL
Mailing Address - Zip Code:35016-5427
Mailing Address - Country:US
Mailing Address - Phone:256-503-4525
Mailing Address - Fax:
Practice Address - Street 1:1339 SPRING VALLEY DR NE
Practice Address - Street 2:
Practice Address - City:ARAB
Practice Address - State:AL
Practice Address - Zip Code:35016-5427
Practice Address - Country:US
Practice Address - Phone:256-503-4525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians