Provider Demographics
NPI:1144897190
Name:BYRD-BRYANT, RONNI
Entity type:Individual
Prefix:
First Name:RONNI
Middle Name:
Last Name:BYRD-BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90037
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29290-1037
Mailing Address - Country:US
Mailing Address - Phone:803-354-8065
Mailing Address - Fax:
Practice Address - Street 1:1113 MILL ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-3763
Practice Address - Country:US
Practice Address - Phone:803-354-8065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-08
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000000OtherSELF PAY