Provider Demographics
NPI:1023313731
Name:BRYAN ABERNATHY, M.D., P.A.
Entity type:Organization
Organization Name:BRYAN ABERNATHY, M.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:ABERNATHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-521-5603
Mailing Address - Street 1:1806 N CROSSOVER RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72701-2725
Mailing Address - Country:US
Mailing Address - Phone:479-521-5603
Mailing Address - Fax:479-521-5773
Practice Address - Street 1:1806 N CROSSOVER RD
Practice Address - Street 2:SUITE 4
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72701-2725
Practice Address - Country:US
Practice Address - Phone:479-521-5603
Practice Address - Fax:479-521-5773
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-12
Last Update Date:2023-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR3155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty