Provider Demographics
NPI:1083502983
Name:BRYAN, CELESTE DIAMOND (APRN)
Entity type:Individual
Prefix:
First Name:CELESTE
Middle Name:DIAMOND
Last Name:BRYAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3506 LAKEVIEW CRK
Mailing Address - Street 2:
Mailing Address - City:STONECREST
Mailing Address - State:GA
Mailing Address - Zip Code:30038-3777
Mailing Address - Country:US
Mailing Address - Phone:828-773-0458
Mailing Address - Fax:
Practice Address - Street 1:3506 LAKEVIEW CRK
Practice Address - Street 2:
Practice Address - City:STONECREST
Practice Address - State:GA
Practice Address - Zip Code:30038-3777
Practice Address - Country:US
Practice Address - Phone:828-773-0458
Practice Address - Fax:828-773-0458
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-27
Last Update Date:2025-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN324343363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily