NPIMap

Individual provider Active NPI

Charles E Bryan Jr., M.D.

  • Family Medicine Physician
  • Tifton, GA
National Provider Identifier
1649282575
Registry record updated Mar 2, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
55184 Issued in GA
Practice address
901 18TH St E
Tifton, GA 31794-3648
Phone
(229) 353-6208
Fax
(229) 353-7722
NPI assigned
Aug 12, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 055184 GA
Family Medicine Physician 207Q00000X 55184 GA Primary

Addresses

Primary practice location

901 18TH St E
Tifton, GA 31794-3648

Mailing address

901 18TH St E
Tifton, GA 31794-3648
Phone (229) 353-6208

Other identifiers 1

IdentifierTypeStateIssuer
055184OtherGAGEORGIA LICENSE NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041118000247 GA Practitioner - Emergency MedicinePractitioner - Family Practice 2264496363 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency MedicineAlso: Family Practice
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Crisp Regional Hospital Inc 65 clinicians

Practice addresses (Care Compare)

902 N 7TH St
Cordele, GA 31015-3234
Phone (229) 276-3100

Hospital & facility affiliations

  • Crisp Regional Hospital Hospital, Cordele, GA, CCN 110104

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
055184GAMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Coffee Emergency Group LLC CurrentSince Mar 1, 2017 Accepting new patients
Crisp Regional Hospital Inc CurrentSince Aug 1, 2024 Accepting new patients
Acs Primary Care Physicians - Southeast PC CurrentSince Jul 31, 2019 Accepting new patients
Crisp Regional Hospital, Inc CurrentSince Aug 1, 2024 Accepting new patients

Locations

902 N 7th St
Cordele, GA 31015
Phone (229) 276-3100

1101 Ocilla Rd
Douglas, GA 31533
Phone (912) 383-5641

2151 W Spring St
Monroe, GA 30655
Phone (770) 267-1792

2225 US Highway 41 N
Tifton, GA 31794
Phone (229) 353-3422

1900 Tebeau St
Waycross, GA 31501
Phone (912) 283-3030

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583107200000",
    "number": "1649282575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-353-6208",
            "fax_number": "229-386-7722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "901 18TH ST E",
            "city": "TIFTON",
            "state": "GA",
            "postal_code": "317943648",
            "telephone_number": "229-353-6208",
            "fax_number": "229-353-7722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYAN",
        "first_name": "CHARLES",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-12",
        "last_updated": "2020-03-02",
        "certification_date": "2020-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "GA",
            "license": "055184",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "GA",
            "license": "55184",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA LICENSE NUMBER",
            "identifier": "055184",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Tifton, GA

Sources for this page

Verify at the official NPI Registry.