Provider Demographics
NPI:1235110701
Name:BRYAN, GASNEL E (MD)
Entity Type:Individual
Prefix:DR
First Name:GASNEL
Middle Name:E
Last Name:BRYAN
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:P.O. BOX 3800
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29802
Mailing Address - Country:US
Mailing Address - Phone:803-648-0874
Mailing Address - Fax:803-648-5665
Practice Address - Street 1:209 ABBEVILLE AVENUE NW
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801
Practice Address - Country:US
Practice Address - Phone:803-648-0874
Practice Address - Fax:803-648-5665
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-10
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC12145207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3802Medicaid
SCD05778Medicare UPIN
SCGP3802Medicaid