MEDICARE: DR. BRYAN P KIRBY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	058688	GA
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	058688	GA

General Provider Information

NPI Number	:	1518183789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN P KIRBY M.D.

Provider Business Mailing Address
First Line	:	150 CLINIC AVENUE
Second Line	:	SUITE 101
City	:	CARROLLTON
State	:	GA
Zip	:	30117
Country	:	US
Telephone Number	:	770-834-0873
Fax Number	:	770-834-6118

Provider Business Practice Location Address
First Line	:	150 CLINIC AVE STE 101
Second Line	:
City	:	CARROLLTON
State	:	GA
Zip	:	30117-4402
Country	:	US
Telephone Number	:	770-834-0873
Fax Number	:	770-834-0873

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	03/17/2018

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