Healthcare Provider Details

I. General information

NPI: 1952845174
Provider Name (Legal Business Name): VERNON BRYANT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 COKEY RD
ROCKY MOUNT NC
27801-5641
US

IV. Provider business mailing address

2001 VERNON RD
ROCKY MOUNT NC
27801-6348
US

V. Phone/Fax

Practice location:
  • Phone: 252-813-1939
  • Fax:
Mailing address:
  • Phone: 252-977-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License NumberFCL033009
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: