Dr. Charles E Bryan Jr., M.D.
Family Medicine in Tifton, GA. Individual provider (NPI-1).
NPI number1649282575
StatusActive
Last updated in NPPESMar 2, 2020
Details
- NPI
- 1649282575
- Entity type
- Individual (NPI-1)
- Name
- Dr. Charles E Bryan Jr.
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Aug 12, 2006
- Certification date
- Mar 2, 2020
- Last updated
- Mar 2, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 55184 | GA | Yes |
| 174400000X | Specialist | 055184 | GA |
Practice location
901 18th St ETifton, GA 31794-3648
Phone 229-353-6208 · Fax 229-353-7722
Mailing address
901 18th St ETifton, GA 31794-3648
Phone 229-353-6208 · Fax 229-386-7722
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