Healthcare Provider Details

I. General information

NPI: 1669654901
Provider Name (Legal Business Name): ELIZABETH D BRYAN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2007
Last Update Date: 11/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

603 BEAMAN ST STE 402
CLINTON NC
28328-2689
US

IV. Provider business mailing address

603 BEAMAN ST STE 402
CLINTON NC
28328-2689
US

V. Phone/Fax

Practice location:
  • Phone: 910-592-8243
  • Fax: 910-592-1552
Mailing address:
  • Phone: 910-592-8243
  • Fax: 910-592-1552

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number200400646
License Number StateNC

VIII. Authorized Official

Name: APRIL PHIPPS
Title or Position: BLLING CLERK
Credential:
Phone: 910-592-8243