Provider Demographics
NPI:1902353659
Name:MCCRARY, WILLIAM BRADLEY (PA-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:BRADLEY
Last Name:MCCRARY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:562 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5382
Mailing Address - Country:US
Mailing Address - Phone:931-854-9601
Mailing Address - Fax:931-854-9605
Practice Address - Street 1:562 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-5382
Practice Address - Country:US
Practice Address - Phone:931-854-9601
Practice Address - Fax:931-854-9605
Is Sole Proprietor?:No
Enumeration Date:2016-09-09
Last Update Date:2018-11-07
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant