MEDICARE: MR. PAUL R BRYANT JR. LMSW

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	1041C0700X	Clinical Social Worker	5814G	AL

General Provider Information

NPI Number	:	1942042841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL R BRYANT JR. LMSW

Provider Business Mailing Address
First Line	:	2441 INTERNATIONAL PARK DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-4252
Country	:	US
Telephone Number	:	205-381-3240
Fax Number	:

Provider Business Practice Location Address
First Line	:	2441 INTERNATIONAL PARK DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35243-4252
Country	:	US
Telephone Number	:	205-381-3240
Fax Number	:

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

Provider Enumeration Date	:	06/11/2024
Last Update Date	:	06/11/2024

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