Basic Information
| Provider Information | |||||||||
| NPI: | 1528261070 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BRYSON | ||||||||
| FirstName: | MOLLY | ||||||||
| MiddleName: | JO | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OTR | ||||||||
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| Mailing Information | |||||||||
| Address1: | 303 HILLDALE AVE | ||||||||
| Address2: | PO BOX 711 | ||||||||
| City: | LAURENS | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293603517 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8649814825 | ||||||||
| FaxNumber: | 8649389240 | ||||||||
| Practice Location | |||||||||
| Address1: | 304 JACOBS HWY | ||||||||
| Address2: | |||||||||
| City: | CLINTON | ||||||||
| State: | SC | ||||||||
| PostalCode: | 293257279 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8648332550 | ||||||||
| FaxNumber: | 8649389240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 183 | SC | Y | Other Service Providers | Specialist |
No ID Information.