Provider Demographics
NPI:1306820741
Name:BRYANT, JILL G (MD)
Entity type:Individual
Prefix:DR
First Name:JILL
Middle Name:G
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 KNIGHT AVE
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-1943
Mailing Address - Country:US
Mailing Address - Phone:912-283-9423
Mailing Address - Fax:912-283-8204
Practice Address - Street 1:711 KNIGHT AVE
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-1943
Practice Address - Country:US
Practice Address - Phone:912-283-9423
Practice Address - Fax:912-283-8204
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA043375207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000755125DMedicaid
GACG6045OtherRAILROAD MEDICARE GROUP ID
GA1306820741OtherMEDICARE NPI
GA000755125DMedicaid