Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD000710 | GA |
Y | 222Z00000X | Podiatrist | POD000710 | GA |
NPI | 1003871013 |
---|---|
Provider Name | Henry Greene Bryant III |
First Address | Evans, GA 30809-3093 |
Second Address | Augusta, GA 30904-4120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 24/07/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00232658C | (05) | GA |
3839091 | MEDICARE NSC (01) | GA |
480026650 | RAILROAD MEDICARE (01) | GA |
48SCBZR | MEDICARE (01) | GA |
52473102 | BLUE CROSS BLUE SHIELD (01) | GA |
U46560 | (02) |