Provider Demographics
NPI:1255382701
Name:BRYANT, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BRYANT
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 1:1215 EAGLES LANDING PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-7279
Mailing Address - Country:US
Mailing Address - Phone:770-389-9116
Mailing Address - Fax:770-506-4580
Practice Address - Street 1:1215 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE 205
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-7279
Practice Address - Country:US
Practice Address - Phone:770-389-9116
Practice Address - Fax:770-506-4580
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA052394174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA07BBSQSMedicare ID - Type Unspecified