Provider Demographics
NPI:1275660144
Name:BRYANT, JEFFREY T (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:T
Last Name:BRYANT
Suffix:
Gender:M
Credentials:PHD
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 425
Mailing Address - Street 2:
Mailing Address - City:GREENBRIER
Mailing Address - State:TN
Mailing Address - Zip Code:37073-0425
Mailing Address - Country:US
Mailing Address - Phone:615-545-6045
Mailing Address - Fax:615-851-8843
Practice Address - Street 1:420 NORTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1524
Practice Address - Country:US
Practice Address - Phone:615-545-6045
Practice Address - Fax:615-851-8843
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP1560103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3684168Medicaid
42326OtherNATIONAL REGISTER OF HSP
R68682Medicare UPIN
TN3684168Medicaid