1881138378 NPI number — MRS. ASHLEY MEADOR BRYAN PA

Table of content: MRS. ASHLEY MEADOR BRYAN PA (NPI 1881138378)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881138378 NPI number — MRS. ASHLEY MEADOR BRYAN PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRYAN
Provider First Name:
ASHLEY
Provider Middle Name:
MEADOR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1881138378
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/02/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9 W BROWNING RD
Provider Second Line Business Mailing Address:
APT 2A
Provider Business Mailing Address City Name:
COLLINGSWOOD
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
08108-1134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-466-2342
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1097A COOK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGEBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29118-8209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-534-5110
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2016

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: 363A00000X , with the licence number:  2937 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: GP6292 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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