MEDICARE: DR. BRYAN K TOLLIVER M.D. PH.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	2084P0800X	Psychiatry Physician	24583	SC

General Provider Information

NPI Number	:	1972684199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRYAN K TOLLIVER M.D. PH.D.

Provider Business Mailing Address
First Line	:	67 PRESIDENT ST
Second Line	:	MEDICAL UNIVERSITY OF SOUTH CAROLINA
City	:	CHARLESTON
State	:	SC
Zip	:	29425-5712
Country	:	US
Telephone Number	:	843-792-4869
Fax Number	:	843-792-0528

Provider Business Practice Location Address
First Line	:	67 PRESIDENT ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29425-5712
Country	:	US
Telephone Number	:	843-792-4869
Fax Number	:	843-792-0528

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	01/13/2022

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