Healthcare Provider Details

I. General information

NPI: 1841108412
Provider Name (Legal Business Name): BREANNA PYE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

174 JAMES KNIGHT RD
JESUP GA
31545-6906
US

IV. Provider business mailing address

174 JAMES KNIGHT RD
JESUP GA
31545-6906
US

V. Phone/Fax

Practice location:
  • Phone: 912-294-2040
  • Fax:
Mailing address:
  • Phone:
  • Fax: 912-294-2040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN-NP302926
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: