Basic Information
| Provider Information | |||||||||
| NPI: | 1407043987 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRADLEY | ||||||||
| FirstName: | CHAUNTAY | ||||||||
| MiddleName: | YVETTE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 698 | ||||||||
| Address2: | |||||||||
| City: | BYHALIA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6628382163 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 12 E BRUNSWICK ST | ||||||||
| Address2: | |||||||||
| City: | BYHALIA | ||||||||
| State: | MS | ||||||||
| PostalCode: | 38611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6625361020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2007 | ||||||||
| LastUpdateDate: | 07/18/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 42908 | TN | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.