Provider Demographics
NPI:1295996312
Name:BRYANT, TAMIKA J (MD)
Entity type:Individual
Prefix:DR
First Name:TAMIKA
Middle Name:J
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TAMIKA
Other - Middle Name:J
Other - Last Name:BASKERVILLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1001 JOHNSON FERRY RD NE
Mailing Address - Street 2:MOB SUITE 500
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-1605
Mailing Address - Country:US
Mailing Address - Phone:404-785-3820
Mailing Address - Fax:
Practice Address - Street 1:1001 JOHNSON FERRY RD NE
Practice Address - Street 2:MOB SUITE 500
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30342-1605
Practice Address - Country:US
Practice Address - Phone:404-785-3820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-20
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA659402080C0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080C0008XAllopathic & Osteopathic PhysiciansPediatricsChild Abuse Pediatrics