Provider Demographics
NPI:1083650279
Name:BRYANT, SUMMER M (NP)
Entity Type:Individual
Prefix:
First Name:SUMMER
Middle Name:M
Last Name:BRYANT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 1ST ST STE 410
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-8306
Mailing Address - Country:US
Mailing Address - Phone:478-314-1658
Mailing Address - Fax:478-743-5264
Practice Address - Street 1:800 1ST ST STE 410
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-8306
Practice Address - Country:US
Practice Address - Phone:478-314-1658
Practice Address - Fax:478-743-5264
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN154368363L00000X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA5125010001Medicare NSC
GAQ38768Medicare UPIN
GA50BBJDVMedicare ID - Type Unspecified