Doctor Name: | SANDRA D BRADDY |
NPI Number: | 1699070797 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | TN PEER SPECIALIST |
License Number: | |
Business Practice Address: | 2035 Saint John Ave Dyersburg, TN - 380242209 |
Business Phone Number: | 7315418344 |
Business Fax Number: | 7315418970 |
Mailing Address: | 238 Summar Dr, JACKSON |
State: | TN |
Postal Code: | 383013906 |
Phone Number: | 7315418344 |
Fax Number: | 7315418970 |
NPI Enumeration Date: | 01/20/2011 |
NPI Last Update Date: | 01/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |