Provider Demographics
NPI:1811916497
Name:BRYANT, HOWARD M (DPM, PC)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:M
Last Name:BRYANT
Suffix:
Gender:M
Credentials:DPM, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2575 SNAPFINGER RD STE D
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-2300
Mailing Address - Country:US
Mailing Address - Phone:770-981-6940
Mailing Address - Fax:770-981-1273
Practice Address - Street 1:2575 SNAPFINGER RD STE D
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-2300
Practice Address - Country:US
Practice Address - Phone:770-981-6940
Practice Address - Fax:770-981-1273
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000439213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA581763565OtherTAXES ID
GA000297778AMedicaid
GA0896580001Medicare NSC