MEDICARE: GLENDA LEE BRYANT FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	135828	GA

General Provider Information

NPI Number	:	1508861592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENDA LEE BRYANT FNP

Provider Business Mailing Address
First Line	:	95 COLLIER RD NW
Second Line	:	STE 2035
City	:	ATLANTA
State	:	GA
Zip	:	30309-1721
Country	:	US
Telephone Number	:	404-355-9515
Fax Number	:	404-350-0529

Provider Business Practice Location Address
First Line	:	95 COLLIER RD NW
Second Line	:	STE 2035
City	:	ATLANTA
State	:	GA
Zip	:	30309-1721
Country	:	US
Telephone Number	:	404-355-9515
Fax Number	:	404-350-0529

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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