Provider Demographics
NPI:1891165817
Name:GRIFFIN, BRADLEY (PA-C)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:BJ
Other - Middle Name:
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:500 S UNIVERSITY AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-5314
Mailing Address - Country:US
Mailing Address - Phone:501-664-3914
Mailing Address - Fax:501-664-0302
Practice Address - Street 1:500 S UNIVERSITY AVE STE 101
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5314
Practice Address - Country:US
Practice Address - Phone:501-664-3914
Practice Address - Fax:501-664-0302
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-02
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP-T1543363A00000X
ARPA-629363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant