MEDICARE: MR. MARCUS DWAYNE BRYAN PH.D, RN

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	363LF0000X	Family Nurse Practitioner	RN319485	GA

General Provider Information

NPI Number	:	1699549709
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARCUS DWAYNE BRYAN PH.D, RN

Provider Business Mailing Address
First Line	:	1050 CROWN POINTE PKWY STE 500
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-7702
Country	:	US
Telephone Number	:	678-727-3274
Fax Number	:

Provider Business Practice Location Address
First Line	:	3950 AUSTELL RD
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-1121
Country	:	US
Telephone Number	:	470-732-4000
Fax Number	:

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

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	06/15/2026

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