Healthcare Provider Details

I. General information

NPI: 1306800669
Provider Name (Legal Business Name): STEPHEN HOWARD BRYANT ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 SMITH ST
ATHENS GA
30603-1472
US

IV. Provider business mailing address

100 SMITH ST
ATHENS GA
30603-1472
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-7885
  • Fax: 706-542-7707
Mailing address:
  • Phone: 706-542-7885
  • Fax: 706-542-7707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT000095
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: