Provider Demographics
NPI:1881221141
Name:BRYAN, JONATHAN ALDEN (DO)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:ALDEN
Last Name:BRYAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5291 HAPPY HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:DUNWOODY
Mailing Address - State:GA
Mailing Address - Zip Code:30360-1261
Mailing Address - Country:US
Mailing Address - Phone:832-477-4745
Mailing Address - Fax:
Practice Address - Street 1:GRAND STRAND MEDICAL CENTER
Practice Address - Street 2:809 82ND PARKWAY
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29572
Practice Address - Country:US
Practice Address - Phone:843-692-1752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-26
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC390200000X
SC87286207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program