Provider Demographics
NPI:1821018441
Name:KIRKLAND, BRYAN THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:THOMAS
Last Name:KIRKLAND
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 1:1016 E SPRING ST
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:GA
Mailing Address - Zip Code:30655-2469
Mailing Address - Country:US
Mailing Address - Phone:770-464-0280
Mailing Address - Fax:770-464-0233
Practice Address - Street 1:1016 E SPRING ST
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:GA
Practice Address - Zip Code:30655-2469
Practice Address - Country:US
Practice Address - Phone:770-464-0280
Practice Address - Fax:770-464-0233
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA057712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA361264217EMedicaid
GA361264217DMedicaid
GA361264217EMedicaid
GA202I118034Medicare PIN