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General NPI Number Information
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NPI Number | 1639758782
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Entity Type | Individual
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Provider Name | RAVEN BRYANT
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Gender | Female
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Dates
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Enumeration Date | 04/06/2021
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 4301 W MARKHAM ST
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City | LITTLE ROCK
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State | AR
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Zip | 72205-7101
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Country | US
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Telephone | 501-603-1656
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Fax |
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Provider Business Mailing Address
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Address Line | 29 LIBERTY HEIGHTS DR
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City | SAVANNAH
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State | GA
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Zip | 31405-2979
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Country | US
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Telephone | 912-667-0747
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 104390
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License Number State | GA
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