Provider Demographics
NPI:1295766681
Name:BRYAN, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:HUNT
Other - Middle Name:
Other - Last Name:BRYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1800 TREE LN STE 290
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-6797
Mailing Address - Country:US
Mailing Address - Phone:770-934-4577
Mailing Address - Fax:770-934-4577
Practice Address - Street 1:1800 TREE LN STE 290
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-6797
Practice Address - Country:US
Practice Address - Phone:770-934-4577
Practice Address - Fax:770-934-4577
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA18616207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00532254AMedicaid
GA023921OtherBCBS GA
GA554817OtherUNITED HEALTHCARE
GA160017334OtherMEDICARE RAILROAD
GA00532254AMedicaid
GA554817OtherUNITED HEALTHCARE