Provider Information for 1316778731
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RANDY BRYANT
Sex: Female
NPI: 1316778731
Last Updated: 2025-01-16
Certification Date: 2025-01-16
Certification Date: 2025-01-16
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1316778731 | ||||||||||||
| Enumeration Date | 2024-08-08 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 2908 BAGPIPE RD COLUMBIA, SC 29223-1802 United States Phone: 803-447-9964 | Fax: | ||||||||||||
| Primary Practice Address | 2908 BAGPIPE RD COLUMBIA, SC 29223-1802 United States Phone: 803-447-9964 | Fax: | ||||||||||||
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