MEDICARE: BRYAN CLARK CRAFTS 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	16328	GA

General Provider Information

NPI Number	:	1588819932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRYAN CLARK CRAFTS M.D.

Provider Business Mailing Address
First Line	:	1440 DUNWOODY CLUB DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-4434
Country	:	US
Telephone Number	:	770-394-5857
Fax Number	:

Provider Business Practice Location Address
First Line	:	1440 DUNWOODY CLUB DR
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30350-4434
Country	:	US
Telephone Number	:	770-394-5857
Fax Number	:

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

Provider Enumeration Date	:	11/27/2008
Last Update Date	:	11/27/2008

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