Provider Demographics
NPI:1922732676
Name:BRYAN, ANNA (MLS)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MLS
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:WHITAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPT
Mailing Address - Street 1:707 PARK AVE NE APT 1313
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30326-3407
Mailing Address - Country:US
Mailing Address - Phone:478-595-4526
Mailing Address - Fax:
Practice Address - Street 1:1332 SOUTHERN DR
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30460-1360
Practice Address - Country:US
Practice Address - Phone:912-478-4636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-10
Last Update Date:2022-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAJ8E8M9S6202K00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology