Provider Demographics
NPI:1639442452
Name:GARRY, BRIAN THOMAS (PA-C)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:THOMAS
Last Name:GARRY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 PARK FORTY PLZ
Mailing Address - Street 2:SUITE 550
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-5249
Mailing Address - Country:US
Mailing Address - Phone:800-291-4042
Mailing Address - Fax:954-267-8419
Practice Address - Street 1:100 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:NC
Practice Address - Zip Code:27549-2256
Practice Address - Country:US
Practice Address - Phone:919-496-5131
Practice Address - Fax:919-497-8018
Is Sole Proprietor?:No
Enumeration Date:2012-02-10
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY028167363A00000X
OH50.007496363A00000X
MAPA9449363A00000X
NC0010-03382363AM0700X
NJ25MP00696300363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical