Provider Demographics
NPI:1073693669
Name:KREPPS, BRYAN KEITH (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:KEITH
Last Name:KREPPS
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 1:503 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224-4211
Mailing Address - Country:US
Mailing Address - Phone:770-227-5505
Mailing Address - Fax:770-412-7881
Practice Address - Street 1:503 S 8TH STREET
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30224
Practice Address - Country:US
Practice Address - Phone:770-227-5505
Practice Address - Fax:770-412-7881
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030125207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00432154AMedicaid
E85245Medicare UPIN
16BDBQRMedicare ID - Type Unspecified