Provider Demographics
NPI:1003150871
Name:BRYANT, JEREMIAH LOUIS (MD)
Entity Type:Individual
Prefix:MR
First Name:JEREMIAH
Middle Name:LOUIS
Last Name:BRYANT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3B SOUTH EMORY UNIVERSITY HOSPITAL 1364 CLIFTON ROAD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-0001
Mailing Address - Country:US
Mailing Address - Phone:800-711-5444
Mailing Address - Fax:404-778-5405
Practice Address - Street 1:3B SOUTH EMORY UNIVERSITY HOSPITAL 1364 CLIFTON ROAD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:800-711-5444
Practice Address - Fax:404-778-5405
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA010114207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program