Provider Demographics
NPI:1760542864
Name:BRYANT, WANDA (RN APRN)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:RN APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 MECHANICSVILLE RD
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533-0840
Mailing Address - Country:US
Mailing Address - Phone:706-867-2727
Mailing Address - Fax:706-867-2739
Practice Address - Street 1:60 MECHANICSVILLE RD
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533-0840
Practice Address - Country:US
Practice Address - Phone:706-867-2727
Practice Address - Fax:706-867-2739
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN047881363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA50BBCWRMedicare ID - Type Unspecified