Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | 054427 | GA |
NPI | 1245296391 |
---|---|
Provider Name | Dr. Brad Prybis |
First Address | Carrollton, GA 30117-4401 |
Second Address | Carrollton, GA 30117-4401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 24/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
304588125A | (05) | GA |
H82583 | (02) | GA |