Healthcare Provider Details

I. General information

NPI: 1023233129
Provider Name (Legal Business Name): YOLANDA BRYANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2007
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 JUAN TABO BLVD NE
ALBUQUERQUE NM
87112-3307
US

IV. Provider business mailing address

1650 SKYLYN DR STE 420
SPARTANBURG SC
29307-1047
US

V. Phone/Fax

Practice location:
  • Phone: 505-237-8800
  • Fax:
Mailing address:
  • Phone: 864-464-7985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2024-1064
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME117255
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: