Healthcare Provider Details

I. General information

NPI: 1104792704
Provider Name (Legal Business Name): BRYSON SIMPSON FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 N PATTERSON ST
VALDOSTA GA
31602-1711
US

IV. Provider business mailing address

172 FLETCHER ST
MORVEN GA
31638-2445
US

V. Phone/Fax

Practice location:
  • Phone: 229-262-6815
  • Fax: 229-219-1790
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP312496
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: