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General NPI Number Information
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NPI Number | 1508287509
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Entity Type | Organization
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Legal Business Name | BRYAN AND SANG MEDICAL ASSOCIATES
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Dates
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Enumeration Date | 12/18/2013
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Last Update Date | 12/18/2013
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Provider Practice Location Address
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Address Line | 209 ABBEVILLE AVE NW
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City | AIKEN
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State | SC
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Zip | 29801-3923
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Country | US
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Telephone | 803-648-0874
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Fax | 803-648-5665
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Provider Business Mailing Address
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Address Line | 209 ABBEVILLE AVE NW
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City | AIKEN
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State | SC
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Zip | 29801
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Country | US
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Telephone | 803-648-0874
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Fax | 803-648-5665
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Authorized Official
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Title or Position | MD
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Name | DR. BRYAN GASNEL
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Credential | M.D.
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Telephone | 803-648-0874
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 12145
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License Number State | SC
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