Individual
BRYANT ALONSO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2941 N ASHLEY ST, VALDOSTA, GA 31602-5945
(229) 253-8500
(229) 253-8522
Mailing address
2941 N ASHLEY ST, VALDOSTA, GA 31602-5945
(229) 253-8500
(229) 253-8522
Taxonomy
Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006569
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OT006569
GEORGIA SECRETARY OF STATE
GA
Enumeration date
09/29/2016
Last updated
09/29/2016
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