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General NPI Number Information
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NPI Number | 1386094852
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Entity Type | Organization
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Legal Business Name | DAVID S. BRYANT
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Dates
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Enumeration Date | 06/15/2016
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Last Update Date | 06/15/2016
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Provider Practice Location Address
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Address Line | 1215 EAGLE LNDNG PKWY
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7279
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Country | US
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Telephone | 770-389-9116
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Fax | 770-506-4580
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Provider Business Mailing Address
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Address Line | 1215 EAGLE LNDNG PKWY
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City | STOCKBRIDGE
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State | GA
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Zip | 30281-7279
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Country | US
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Telephone | 770-389-9116
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Fax | 770-506-4580
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DAVID S BRYANT
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Credential | MD
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Telephone | 678-656-7203
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 52394
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License Number State | GA
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