Provider Demographics
NPI:1700847613
Name:BRYANT, LOIS E (NURSE PRACTIONER)
Entity Type:Individual
Prefix:
First Name:LOIS
Middle Name:E
Last Name:BRYANT
Suffix:
Gender:F
Credentials:NURSE PRACTIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-1912
Mailing Address - Country:US
Mailing Address - Phone:706-253-2821
Mailing Address - Fax:706-253-5863
Practice Address - Street 1:60 HEALTH WAY
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-1912
Practice Address - Country:US
Practice Address - Phone:706-253-2821
Practice Address - Fax:706-253-5863
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN023073363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health