Healthcare Provider Details

I. General information

NPI: 1699178764
Provider Name (Legal Business Name): JAMES PATRICK BRYSON CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2014
Last Update Date: 10/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1488 JESSE JEWELL PKWY SE SUITE 100
GAINESVILLE GA
30501-3803
US

IV. Provider business mailing address

1560 CARLTON DR
CUMMING GA
30040-7814
US

V. Phone/Fax

Practice location:
  • Phone: 770-532-7179
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN195967
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: