Healthcare Provider Details

I. General information

NPI: 1942116363
Provider Name (Legal Business Name): ISELA VILLASANA BRYANT FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

673 PINE ST
MACON GA
31201-7904
US

IV. Provider business mailing address

673 PINE ST
MACON GA
31201-7904
US

V. Phone/Fax

Practice location:
  • Phone: 478-743-9123
  • Fax: 478-742-9809
Mailing address:
  • Phone: 478-743-9123
  • Fax: 478-742-9809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberAPRN-NP323216
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: