Provider Demographics
NPI:1003871013
Name:BRYANT, HENRY GREENE III (DPM)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:GREENE
Last Name:BRYANT
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4321 UNIVERSITY PKWY
Mailing Address - Street 2:BLDG 2 SUITE 103
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3093
Mailing Address - Country:US
Mailing Address - Phone:706-738-1925
Mailing Address - Fax:706-738-0705
Practice Address - Street 1:2030 WALTON WAY
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4120
Practice Address - Country:US
Practice Address - Phone:706-738-1925
Practice Address - Fax:706-738-0705
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000710213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00232658CMedicaid
GA480026650OtherRAILROAD MEDICARE
GA52473102OtherBLUE CROSS BLUE SHIELD
GA3839091OtherMEDICARE NSC
GA48SCBZROtherMEDICARE
GA00232658CMedicaid