Provider Demographics
NPI:1821338849
Name:CANTLEY, BRADLEY W
Entity Type:Individual
Prefix:
First Name:BRADLEY
Middle Name:W
Last Name:CANTLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:W
Other - Last Name:CANTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:3630 OAK MOUNTAIN STATE PARK RD
Mailing Address - Street 2:
Mailing Address - City:PELHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35124-4375
Mailing Address - Country:US
Mailing Address - Phone:205-368-9907
Mailing Address - Fax:256-245-6002
Practice Address - Street 1:1023 W FORT WILLIAMS ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2301
Practice Address - Country:US
Practice Address - Phone:256-245-6700
Practice Address - Fax:256-245-6002
Is Sole Proprietor?:No
Enumeration Date:2013-02-28
Last Update Date:2013-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA.879363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant