Provider Demographics
NPI:1306800669
Name:BRYANT, STEPHEN HOWARD (ATC)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:HOWARD
Last Name:BRYANT
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30603-1472
Mailing Address - Country:US
Mailing Address - Phone:706-542-7885
Mailing Address - Fax:706-542-7707
Practice Address - Street 1:100 SMITH ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30603-1472
Practice Address - Country:US
Practice Address - Phone:706-542-7885
Practice Address - Fax:706-542-7707
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0000952255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer