Provider Demographics
NPI:1750887675
Name:BRYAN, BRENDA GAIL (NP-C)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:GAIL
Last Name:BRYAN
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1804 FORKS RD
Mailing Address - Street 2:
Mailing Address - City:MILLWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:31552-3014
Mailing Address - Country:US
Mailing Address - Phone:912-327-1421
Mailing Address - Fax:
Practice Address - Street 1:1804 FORKS RD
Practice Address - Street 2:
Practice Address - City:MILLWOOD
Practice Address - State:GA
Practice Address - Zip Code:31552-3014
Practice Address - Country:US
Practice Address - Phone:912-327-1421
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN231570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily