Provider Demographics
NPI:1578590790
Name:BRYANT, CALVIN DON (MD)
Entity Type:Individual
Prefix:
First Name:CALVIN
Middle Name:DON
Last Name:BRYANT
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 1:4144 CLEMSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621
Mailing Address - Country:US
Mailing Address - Phone:864-224-9598
Mailing Address - Fax:864-226-2462
Practice Address - Street 1:4144 CLEMSON BLVD
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621
Practice Address - Country:US
Practice Address - Phone:864-224-9598
Practice Address - Fax:864-226-2462
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC8960207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC089601Medicaid
SC089601Medicaid