Provider Demographics
NPI:1659516326
Name:FAGAN, RYAN PATRICK (MD, MPH)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:PATRICK
Last Name:FAGAN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 CLIFTON ROAD NE
Mailing Address - Street 2:BUILDING 1, MS D-63
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30333
Mailing Address - Country:US
Mailing Address - Phone:404-708-1154
Mailing Address - Fax:404-639-3535
Practice Address - Street 1:1600 CLIFTON ROAD NE
Practice Address - Street 2:BUILDING 1, MS D-63
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30333
Practice Address - Country:US
Practice Address - Phone:404-708-1154
Practice Address - Fax:404-639-3535
Is Sole Proprietor?:No
Enumeration Date:2008-12-10
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.15556R207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine