Healthcare Provider Details

I. General information

NPI: 1164129128
Provider Name (Legal Business Name): BRYAN KELLY MCDONALD FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 HIGHWAY 441 N STE 100
CLAYTON GA
30525-6446
US

IV. Provider business mailing address

PO BOX 459
COLBERT GA
30628-0459
US

V. Phone/Fax

Practice location:
  • Phone: 706-782-5991
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN257567
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: