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General NPI Number Information
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NPI Number | 1285646950
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Entity Type | Organization
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Legal Business Name | GARY B. BRYANT, MD, PC
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 04/14/2009
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Provider Practice Location Address
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Address Line | 119 E FORT ST
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City | MANCHESTER
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State | TN
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Zip | 37355-1508
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Country | US
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Telephone | 931-728-4477
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Fax | 931-728-4997
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Provider Business Mailing Address
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Address Line | PO BOX 240
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City | MANCHESTER
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State | TN
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Zip | 37349-0240
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Country | US
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Telephone | 931-728-4477
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Fax | 931-728-4997
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Authorized Official
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Title or Position | PRESIDENT
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Name | GARY B BRYANT
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Credential | MD
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Telephone | 931-728-4477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD009298
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License Number State | TN
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