Provider Demographics
NPI:1881138378
Name:BRYAN, ASHLEY MEADOR (PA)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:MEADOR
Last Name:BRYAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 W BROWNING RD
Mailing Address - Street 2:APT 2A
Mailing Address - City:COLLINGSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08108-1134
Mailing Address - Country:US
Mailing Address - Phone:864-466-2342
Mailing Address - Fax:
Practice Address - Street 1:1097A COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8209
Practice Address - Country:US
Practice Address - Phone:803-534-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2937363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP6292Medicaid