Doctor Name: | HARRIETTE PEACOCK BRYANT |
NPI Number: | 1164778411 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CPED, CFM |
License Number: | |
Business Practice Address: | 7130 Blue Ridge Dr Blue Ridge, GA - 305133605 |
Business Phone Number: | 7066320384 |
Business Fax Number: | 7069460385 |
Mailing Address: | 7130 Blue Ridge Dr, BLUE RIDGE |
State: | GA |
Postal Code: | 305133605 |
Phone Number: | 7066320384 |
Fax Number: | 7069460385 |
NPI Enumeration Date: | 07/24/2012 |
NPI Last Update Date: | 07/01/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 224900000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Respiratory, Developmental, Rehabilitative and Restorative Service Providers |
Taxonomy Classification: | Mastectomy Fitter |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual trained in the fitting and adjusting of breast prostheses and management of post-mastectomy prostheses services. |