Healthcare Provider Details

I. General information

NPI: 1518737527
Provider Name (Legal Business Name): MARJEANNA GWEN BRYANT APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2024
Last Update Date: 01/02/2024
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 PEACHTREE ST NE SUITE 500
ATLANTA GA
30309
US

IV. Provider business mailing address

5360 ALLATOONA GTWY APT 1203
ACWORTH GA
30101-7411
US

V. Phone/Fax

Practice location:
  • Phone: 770-702-0101
  • Fax:
Mailing address:
  • Phone: 770-878-0910
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberRN209216
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: