Healthcare Provider Details

I. General information

NPI: 1144204645
Provider Name (Legal Business Name): DENISE ABSHER BRYANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 DOCTOR STREET
SPARTA NC
28675-9247
US

IV. Provider business mailing address

214 DOCTOR STREET
SPARTA NC
28675-9247
US

V. Phone/Fax

Practice location:
  • Phone: 336-372-5606
  • Fax: 336-372-6211
Mailing address:
  • Phone: 336-372-5606
  • Fax: 336-372-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number200100112
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: