Provider Demographics
NPI:1740675487
Name:BRYSON, ALAN (PA)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:BRYSON
Suffix:
Gender:M
Credentials:PA
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 247
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MS
Mailing Address - Zip Code:39441-0247
Mailing Address - Country:US
Mailing Address - Phone:601-428-0577
Mailing Address - Fax:601-426-9854
Practice Address - Street 1:1440 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-4243
Practice Address - Country:US
Practice Address - Phone:601-428-0577
Practice Address - Fax:601-426-9854
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMB3463938363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical