Provider Demographics
NPI:1750303806
Name:CASEY, BRYAN HODGES (DO)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:HODGES
Last Name:CASEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:420 THOMSON CIR STE B
Mailing Address - Street 2:
Mailing Address - City:ABBEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29620-5656
Mailing Address - Country:US
Mailing Address - Phone:864-366-3001
Mailing Address - Fax:864-366-3317
Practice Address - Street 1:420 THOMSON CIR STE B
Practice Address - Street 2:
Practice Address - City:ABBEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29620-5656
Practice Address - Country:US
Practice Address - Phone:864-366-3001
Practice Address - Fax:864-366-3317
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1040207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC10400Medicaid
SCH924741124Medicare PIN
SCH92474Medicare UPIN