Provider Demographics
NPI:1922512748
Name:BRYANT, INEZ (CNA)
Entity Type:Individual
Prefix:
First Name:INEZ
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 VILLAGE CRK
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30238-7967
Mailing Address - Country:US
Mailing Address - Phone:678-665-7216
Mailing Address - Fax:
Practice Address - Street 1:1138 VILLAGE CRK
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:GA
Practice Address - Zip Code:30238-7967
Practice Address - Country:US
Practice Address - Phone:678-665-7216
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACN0014205430376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes376K00000XNursing Service Related ProvidersNurse's AideGroup - Single Specialty