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General NPI Number Information
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NPI Number | 1124635594
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Entity Type | Organization
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Legal Business Name | BRYN MEDICAL PLLC
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Dates
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Enumeration Date | 09/29/2020
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Last Update Date | 07/19/2021
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Provider Practice Location Address
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Address Line | 6221 SHALLOWFORD RD STE 100
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City | CHATTANOOGA
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State | TN
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Zip | 37421-1972
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Country | US
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Telephone | 423-954-7003
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Fax |
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Provider Business Mailing Address
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Address Line | 4295 CROMWELL RD STE 301
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City | CHATTANOOGA
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State | TN
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Zip | 37421-2163
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | ABBY ROBERTSON
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Credential |
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Telephone | 423-954-7003
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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