Provider Demographics
NPI:1457320608
Name:BRYANT, ANTHONY (CRNA)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:BRYANT
Suffix:
Gender:M
Credentials:CRNA
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 18824
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27419-8824
Mailing Address - Country:US
Mailing Address - Phone:336-553-1659
Mailing Address - Fax:336-553-3994
Practice Address - Street 1:410 DARLING AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-5246
Practice Address - Country:US
Practice Address - Phone:912-338-6511
Practice Address - Fax:336-553-3994
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2010-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN109243367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00351833OtherRR MEDICARE
GA000885442KMedicaid
GA000885442MMedicaid
GA000885442MMedicaid
IN146000QMedicare PIN
GAP00351833OtherRR MEDICARE
GAP00351833Medicare PIN
IN258290OMedicare PIN
GA43BBCRBMedicare PIN