Individual
DR. CHARLES E BRYAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-6208
(229) 353-7722
Mailing address
901 18TH ST E, TIFTON, GA 31794-3648
(229) 353-6208
(229) 386-7722
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
055184
GA
207Q00000X
Family Medicine Physician
Primary
55184
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055184
GEORGIA LICENSE NUMBER
GA
Enumeration date
08/12/2006
Last updated
03/02/2020
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