Provider Demographics
NPI:1154544575
Name:DYER-MCPHERSON, BRADLEIGH (FNP)
Entity type:Individual
Prefix:
First Name:BRADLEIGH
Middle Name:
Last Name:DYER-MCPHERSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 COLWELL CHURCH RD.
Mailing Address - Street 2:
Mailing Address - City:EPWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30541
Mailing Address - Country:US
Mailing Address - Phone:706-258-2580
Mailing Address - Fax:
Practice Address - Street 1:350 COLWELL CHURCH RD. EPWORTH, GA 30541
Practice Address - Street 2:28 SOUTHSIDE CHURCH ST.
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540
Practice Address - Country:US
Practice Address - Phone:706-635-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily