MEDICARE: J.BRYAN, INC

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	3336S0011X	Specialty Pharmacy	PHRE009369	GA
2	3336C0003X	Community/Retail Pharmacy	PHRE009369	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PHRE007469	OTHER	GA	BOARD OF PHARMACY
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1138278	OTHER	GA	NCPDP

General Provider Information

NPI Number	:	1922031244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	J.BRYAN, INC

Provider Business Mailing Address
First Line	:	PO BOX 2267
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31203-2267
Country	:	US
Telephone Number	:	478-741-3718
Fax Number	:	478-741-6559

Provider Business Practice Location Address
First Line	:	900 GRAY HWY
Second Line	:
City	:	MACON
State	:	GA
Zip	:	31211-1834
Country	:	US
Telephone Number	:	478-741-3718
Fax Number	:	478-741-6559

Authorized Official
Title or Position	:	PHARMACIST/PRESIDENT
Name	:	MR. WADE W SCOTT
Credential	:	R.PH.
Telephone Number	:	478-741-3718

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	03/07/2023

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Directions to “J.BRYAN, INC ” Practice Location

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