Provider Demographics
NPI:1518183789
Name:KIRBY, BRYAN P (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:P
Last Name:KIRBY
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 1:150 CLINIC AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30117
Mailing Address - Country:US
Mailing Address - Phone:770-834-0873
Mailing Address - Fax:770-834-6118
Practice Address - Street 1:150 CLINIC AVE STE 101
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-4402
Practice Address - Country:US
Practice Address - Phone:770-834-0873
Practice Address - Fax:770-834-0873
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA058688207L00000X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology