Most Relevant Information
Provider Data
| NPI Number: | 1003643412 |
| Provider Name: | BRADLEY FAREL HATHAWAY |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 09/18/2024 |
| Last Updated: | 09/18/2024 |
Provider Practice Location
167 BAYOU RD
GREENVILLE
MS
387017732
Practice Location Phone/Fax
| Phone: | 6628203939 |
| Fax: |
Provider Mailing Location
167 BAYOU RD
GREENVILLE
MS
387017732
Provider Mailing Phone/Fax
| Phone: | 6628203939 |
| Fax: |