MEDICARE: MRS. ASHLEY MEADOR BRYAN PA

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
1	363A00000X	Physician Assistant	2937	SC

Other Identifiers

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

General Provider Information

NPI Number	:	1881138378
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY MEADOR BRYAN PA

Provider Business Mailing Address
First Line	:	9 W BROWNING RD
Second Line	:	APT 2A
City	:	COLLINGSWOOD
State	:	NJ
Zip	:	08108-1134
Country	:	US
Telephone Number	:	864-466-2342
Fax Number	:

Provider Business Practice Location Address
First Line	:	1097A COOK RD
Second Line	:
City	:	ORANGEBURG
State	:	SC
Zip	:	29118-8209
Country	:	US
Telephone Number	:	803-534-5110
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2016
Last Update Date	:	08/02/2018

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