Healthcare Provider Details

I. General information

NPI: 1265830186
Provider Name (Legal Business Name): BRYANT NURSING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 SE 6TH STREET
COCHRAN GA
31014
US

IV. Provider business mailing address

3066 ALBERTA DR
MARIETTA GA
30062-1513
US

V. Phone/Fax

Practice location:
  • Phone: 478-934-7682
  • Fax:
Mailing address:
  • Phone: 423-544-1964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOT005848
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: LORA WELLS
Title or Position: OCCUPATIONAL THERAPIST
Credential: OTR/L
Phone: 423-544-1964