Provider Demographics
NPI:1588819932
Name:CRAFTS, BRYAN CLARK (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:CLARK
Last Name:CRAFTS
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 1:1440 DUNWOODY CLUB DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-4434
Mailing Address - Country:US
Mailing Address - Phone:770-394-5857
Mailing Address - Fax:
Practice Address - Street 1:1440 DUNWOODY CLUB DR
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-4434
Practice Address - Country:US
Practice Address - Phone:770-394-5857
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-27
Last Update Date:2008-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA16328207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology