| Doctor Name: | DR. JEREMY GILLIAM BRADLEY |
| NPI Number: | 1922362722 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | |
| Business Practice Address: | 2195 Euclid Ave Suite 6 Bristol, VA - 242013655 |
| Business Phone Number: | 2766695179 |
| Business Fax Number: | 2764668870 |
| Mailing Address: | Po Box 729, SALTVILLE |
| State: | VA |
| Postal Code: | 243700729 |
| Phone Number: | 2764964492 |
| Fax Number: | 2764964839 |
| NPI Enumeration Date: | 06/27/2012 |
| NPI Last Update Date: | 06/29/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |