Healthcare Provider Details

I. General information

NPI: 1073451126
Provider Name (Legal Business Name): ANTHONY AARON BRYSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1912 MEMORIAL DR STE E
WAYCROSS GA
31501-0989
US

IV. Provider business mailing address

216 FORT MCINTOSH LOOP
HORTENSE GA
31543-9879
US

V. Phone/Fax

Practice location:
  • Phone: 912-283-7100
  • Fax:
Mailing address:
  • Phone: 912-402-4988
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number225092
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: