Active NPI
Bradford Armande Pettaway
- Home Health Aide
- Saraland, AL
National Provider Identifier
1124605340
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Aide
- Practice address
- 720 Doby LN
Saraland, AL 36571-2340 - Phone
- (251) 327-9946
- Fax
- (251) 675-1749
- NPI assigned
- Mar 24, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Aide | 374U00000X | AL | ||
| Home Health Aide | 374U00000X | Primary |
Addresses
Primary practice location
720 Doby LN
Saraland, AL 36571-2340
Mailing address
720 Doby LN
Saraland, AL 36571-2340
Phone (251) 327-9946
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1616544000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1616544000000",
"number": "1124605340",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "720 DOBY LN",
"city": "SARALAND",
"state": "AL",
"postal_code": "365712340",
"telephone_number": "251-327-9946"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 DOBY LN",
"city": "SARALAND",
"state": "AL",
"postal_code": "365712340",
"telephone_number": "251-327-9946",
"fax_number": "251-675-1749"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETTAWAY",
"first_name": "BRADFORD",
"middle_name": "ARMANDE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-03-24",
"last_updated": "2021-03-24",
"certification_date": "2021-03-24",
"status": "A"
},
"taxonomies": [
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": "AL",
"license": null,
"primary": false
},
{
"code": "374U00000X",
"taxonomy_group": "",
"desc": "Home Health Aide",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saraland, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.