Provider Demographics
NPI:1528037660
Name:BRYANT, ERIN E (MD)
Entity Type:Individual
Prefix:MISS
First Name:ERIN
Middle Name:E
Last Name:BRYANT
Suffix:
Gender:F
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:PO BOX 3889
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37602-3889
Mailing Address - Country:US
Mailing Address - Phone:423-794-2457
Mailing Address - Fax:423-283-9480
Practice Address - Street 1:301 MED TECH PKWY STE 140
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2364
Practice Address - Country:US
Practice Address - Phone:423-794-5530
Practice Address - Fax:423-928-1685
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN37730207P00000X
TNMD0000037730208D00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4105806OtherBLUE CROSS BLUE SHIELD PR
VA1528037660Medicaid
KY7100153200Medicaid
TN3327757Medicaid
TN3327758Medicare PIN
TN103I084338Medicare PIN
TNI25365Medicare UPIN