1013288505 NPI number — DR. TERRY N BRYANT PHARMD

Table of content: DR. TERRY N BRYANT PHARMD (NPI 1013288505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013288505 NPI number — DR. TERRY N BRYANT PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYANT
Provider First Name:
TERRY
Provider Middle Name:
N
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013288505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6381 HAMILTON ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRESTON
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31824-4029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-828-2273
Provider Business Mailing Address Fax Number:
229-828-2115

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6381 HAMILTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRESTON
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-828-2273
Provider Business Practice Location Address Fax Number:
229-828-2115
Provider Enumeration Date:
01/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH021607 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: RPH021607 . This is a "STATE PHARMACY LICENSE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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