Provider Demographics
NPI:1770682676
Name:BRYANT, JAMES EARL (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EARL
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MD
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 602373
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-2373
Mailing Address - Country:US
Mailing Address - Phone:828-213-1500
Mailing Address - Fax:828-651-6570
Practice Address - Street 1:377 GALLIMORE RD
Practice Address - Street 2:
Practice Address - City:BREVARD
Practice Address - State:NC
Practice Address - Zip Code:28712-8874
Practice Address - Country:US
Practice Address - Phone:828-884-9030
Practice Address - Fax:828-884-3563
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-00343207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNCA619DOtherMEDICARE PTAN
NCNCA619BOtherMEDICARE PTAN
NCNCA619AOtherMEDICARE PTAN
NCNCA619COtherMEDICARE PTAN
NCNCA619AOtherMEDICARE PTAN