Provider Demographics
NPI:1467027334
Name:BRADLEY, ALLI NICKELL (DO)
Entity type:Individual
Prefix:
First Name:ALLI
Middle Name:NICKELL
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALLI
Other - Middle Name:JOHANNA
Other - Last Name:NICKELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1275 DICK LONAS RD UNIT 101
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-1383
Mailing Address - Country:US
Mailing Address - Phone:865-584-4747
Mailing Address - Fax:865-381-1509
Practice Address - Street 1:1404 TUSCULUM BLVD STE 3000
Practice Address - Street 2:
Practice Address - City:GREENEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37745-4648
Practice Address - Country:US
Practice Address - Phone:423-638-1188
Practice Address - Fax:833-908-2068
Is Sole Proprietor?:No
Enumeration Date:2021-05-24
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5441207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine