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NPI Code Detail

MEDICARE: DR. ALTON E BRYANT III MD

MEDICARE: DR. ALTON E BRYANT III MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084N0400XNeurology Physician200501498NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1083693964
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALTON E BRYANT III MD
Provider Business Mailing Address
First Line : PO BOX 751803
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1803
Country : US
Telephone Number : 336-718-4820
Fax Number : 704-784-7830
Provider Business Practice Location Address
First Line : 2025 FRONTIS PLAZA BLVD
Second Line : SUITE 120
City : WINSTON SALEM
State : NC
Zip : 27103-5663
Country : US
Telephone Number : 336-277-2200
Fax Number : 336-277-2210
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/10/2006
Last Update Date : 03/07/2023

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