Provider Demographics
NPI:1194222067
Name:WHAM, BRADLEY COMPTON
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:COMPTON
Last Name:WHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1915 LENDEW ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7094
Mailing Address - Country:US
Mailing Address - Phone:363-275-3325
Mailing Address - Fax:336-275-5346
Practice Address - Street 1:1915 LENDEW ST STE 100
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7094
Practice Address - Country:US
Practice Address - Phone:363-275-3325
Practice Address - Fax:336-275-5346
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2025-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2024-02112207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine