Provider Demographics
NPI:1245296391
Name:PRYBIS, BRAD (MD)
Entity type:Individual
Prefix:DR
First Name:BRAD
Middle Name:
Last Name:PRYBIS
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 1:135 N PARK PL STE 101
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7237
Mailing Address - Country:US
Mailing Address - Phone:770-892-0300
Mailing Address - Fax:470-878-1495
Practice Address - Street 1:135 N PARK PL STE 101
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7237
Practice Address - Country:US
Practice Address - Phone:770-892-0300
Practice Address - Fax:470-878-1495
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054427207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA304588125AMedicaid
GAH82583Medicare UPIN
GA304588125AMedicaid