Provider Demographics
NPI:1851462204
Name:DE MARCO, BRYAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:J
Last Name:DE MARCO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3969 S COBB DR SE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-6358
Mailing Address - Country:US
Mailing Address - Phone:770-432-5326
Mailing Address - Fax:770-432-5740
Practice Address - Street 1:3969 S COBB DR SE
Practice Address - Street 2:SUITE 206
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-6358
Practice Address - Country:US
Practice Address - Phone:770-432-5326
Practice Address - Fax:770-432-5740
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
GA030987207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA16BBCDHMedicare ID - Type Unspecified