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General NPI Number Information
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NPI Number | 1679003339
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Entity Type | Individual
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Provider Name | CHARLES BARRON BRYANT DO
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Gender | Male
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Dates
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Enumeration Date | 06/15/2017
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Last Update Date | 06/15/2017
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Provider Practice Location Address
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Address Line | 165 ASHLEY AVE
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City | CHARLESTON
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State | SC
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Zip | 29425-8905
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Country | US
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Telephone | 828-691-5105
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Fax |
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Provider Business Mailing Address
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Address Line | 169 ASHLEY AVENUE ROOM 202 MAIN HOSPITAL MSC333
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City | CHARLESTON
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State | SC
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Zip | 29425
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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 |
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | LL40714
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License Number State | SC
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