Healthcare Provider Details

I. General information

NPI: 1801459375
Provider Name (Legal Business Name): SEVARA BRYANT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2019
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1412 MILSTEAD AVE NE
CONYERS GA
30012-3877
US

IV. Provider business mailing address

250 SMITH CHURCH RD
ROANOKE RAPIDS NC
27870-4914
US

V. Phone/Fax

Practice location:
  • Phone: 770-918-3000
  • Fax:
Mailing address:
  • Phone: 252-535-8011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number93899
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: