| Doctor Name: | DR. MACON SAMUEL BRADLEY |
| NPI Number: | 1851521744 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | 03294 |
| Business Practice Address: | 153 Dowell Rd Russell Springs, KY - 426424579 |
| Business Phone Number: | 2708664141 |
| Business Fax Number: | |
| Mailing Address: | P.o. Box 1610, Dowell Rd RUSSELL SPRINGS |
| State: | KY |
| Postal Code: | 42642 |
| Phone Number: | 2708664141 |
| Fax Number: | |
| NPI Enumeration Date: | 07/25/2009 |
| NPI Last Update Date: | 08/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0401X |
| License Number: | 03294 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Addiction Medicine |
| Taxonomy Definition: | A family medicine physician who specializes in the diagnosis and treatment of addictions. |