Healthcare Provider Details

I. General information

NPI: 1386769578
Provider Name (Legal Business Name): BETH C BRYANT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 JOHNSON FERRY RD STE 130
ATLANTA GA
30342-1601
US

IV. Provider business mailing address

1120 15TH ST BA 8300
AUGUSTA GA
30912-0004
US

V. Phone/Fax

Practice location:
  • Phone: 404-300-2990
  • Fax: 404-300-2986
Mailing address:
  • Phone: 706-446-5802
  • Fax: 706-721-3838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN061119
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: