Provider Demographics
NPI:1043943665
Name:BRADLEY, EMMA (MS, CGC)
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:BRADLEY
Suffix:
Gender:F
Credentials:MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 N DUNLAP ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38103-2802
Mailing Address - Country:US
Mailing Address - Phone:901-287-6438
Mailing Address - Fax:901-287-6453
Practice Address - Street 1:49 N DUNLAP ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2802
Practice Address - Country:US
Practice Address - Phone:901-287-6438
Practice Address - Fax:901-287-6453
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS