Healthcare Provider Details

I. General information

NPI: 1922031244
Provider Name (Legal Business Name): J.BRYAN, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 GRAY HWY
MACON GA
31211-1834
US

IV. Provider business mailing address

PO BOX 2267
MACON GA
31203-2267
US

V. Phone/Fax

Practice location:
  • Phone: 478-741-3718
  • Fax: 478-741-6559
Mailing address:
  • Phone: 478-741-3718
  • Fax: 478-741-6559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE009369
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHRE009369
License Number StateGA

VIII. Authorized Official

Name: MR. WADE W SCOTT
Title or Position: PHARMACIST/PRESIDENT
Credential: R.PH.
Phone: 478-741-3718