Healthcare Provider Details

I. General information

NPI: 1053512053
Provider Name (Legal Business Name): DENEIKA BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2100 COMER AVE
COLUMBUS GA
31904-8725
US

IV. Provider business mailing address

5963 BIG OAK DR
COLUMBUS GA
31909-4441
US

V. Phone/Fax

Practice location:
  • Phone: 706-596-5541
  • Fax: 706-596-5780
Mailing address:
  • Phone: 706-662-7096
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: