Provider Demographics
NPI:1164063814
Name:BRYANT, CHANTAE ALETHA (PMH-NP)
Entity Type:Individual
Prefix:
First Name:CHANTAE
Middle Name:ALETHA
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PMH-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 PLANTATION PARK DR
Mailing Address - Street 2:
Mailing Address - City:LOGANVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30052-4144
Mailing Address - Country:US
Mailing Address - Phone:678-344-8268
Mailing Address - Fax:888-627-6444
Practice Address - Street 1:500 PLANTATION PARK DR
Practice Address - Street 2:
Practice Address - City:LOGANVILLE
Practice Address - State:GA
Practice Address - Zip Code:30052-4144
Practice Address - Country:US
Practice Address - Phone:678-344-8268
Practice Address - Fax:888-627-6444
Is Sole Proprietor?:No
Enumeration Date:2019-10-03
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227249363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health