Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 82165 | GA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 82165 | GA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | MD52054 | SC |
NPI | 1821437757 |
---|---|
Provider Name | Dr. Cory A Bryan |
First Address | Greenville, SC 29605-4255 |
Second Address | Augusta, GA 30912-0004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/06/2013 |
Last Update Date | 03/04/2019 |