Provider Demographics
NPI:1558312231
Name:BRYSON, ISRAEL D (MD)
Entity Type:Individual
Prefix:MR
First Name:ISRAEL
Middle Name:D
Last Name:BRYSON
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 1:207 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-2727
Mailing Address - Country:US
Mailing Address - Phone:478-787-4266
Mailing Address - Fax:
Practice Address - Street 1:2251 W ELM ST
Practice Address - Street 2:
Practice Address - City:WRIGHTSVILLE
Practice Address - State:GA
Practice Address - Zip Code:31096-2017
Practice Address - Country:US
Practice Address - Phone:478-864-3448
Practice Address - Fax:478-864-1288
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054797207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA054797OtherPROVIDER STATE LICENSE
GABB8823141OtherPROVIDER DEA
GA054797OtherPROVIDER STATE LICENSE
GABB8823141OtherPROVIDER DEA