Provider Demographics
NPI:1659762847
Name:BRYANT III, CHARLES WILLIAM III (PEER SUPPORT SPECIAL)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:WILLIAM
Last Name:BRYANT III
Suffix:III
Gender:M
Credentials:PEER SUPPORT SPECIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 E ORDNANCE RD
Mailing Address - Street 2:
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21060-2200
Mailing Address - Country:US
Mailing Address - Phone:410-222-4939
Mailing Address - Fax:410-222-6364
Practice Address - Street 1:600 E ORDNANCE RD
Practice Address - Street 2:
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21060-2200
Practice Address - Country:US
Practice Address - Phone:410-222-4939
Practice Address - Fax:410-222-6364
Is Sole Proprietor?:No
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist