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General NPI Number Information
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NPI Number | 1316996572
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Entity Type | Individual
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Provider Name | KRISTY LYNN BRYAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/08/2006
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Last Update Date | 09/23/2009
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Provider Practice Location Address
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Address Line | 1500 WEST POPLAR AVENUE SUITE 202
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City | COLLIERVILLE
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State | TN
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Zip | 38017
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Country | US
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Telephone | 901-861-9090
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Fax | 901-861-9099
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Provider Business Mailing Address
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Address Line | P.O. BOX 405827
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City | ATLANTA
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State | GA
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Zip | 30384-5827
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Country | US
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Telephone | 870-934-5821
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Fax | 870-934-5384
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD0000039119
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 39119
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License Number State | TN
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