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General NPI Number Information
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NPI Number | 1083525588
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Entity Type | Individual
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Provider Name | COURTNEE BRYANT COO
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Gender | Female
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Dates
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Enumeration Date | 09/14/2026
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Last Update Date | 09/14/2026
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Provider Practice Location Address
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Address Line | 3030 RAPIDS DR
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City | DECATUR
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State | GA
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Zip | 30034-3262
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Country | US
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Telephone | 770-865-4545
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Fax |
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Provider Business Mailing Address
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Address Line | 1016 SE 1ST ST
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City | LAWTON
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State | OK
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Zip | 73501-2405
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Country | US
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Telephone | 877-514-1071
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number |
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License Number State |
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