Healthcare Provider Details

I. General information

NPI: 1952983710
Provider Name (Legal Business Name): GREGORY CHARLES BRYANT CO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2021
Last Update Date: 04/11/2022
Certification Date: 04/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3334 CAPITAL MEDICAL BLVD STE 400
TALLAHASSEE FL
32308-4470
US

IV. Provider business mailing address

3334 CAPITAL MEDICAL BLVD STE 400
TALLAHASSEE FL
32308-4470
US

V. Phone/Fax

Practice location:
  • Phone: 850-877-8174
  • Fax: 844-261-6839
Mailing address:
  • Phone: 850-877-8174
  • Fax: 844-261-6839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberPOR410
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberORT337
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberPOR410
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: