Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 010114 | GA |
NPI | 1003150871 |
---|---|
Provider Name | Mr. Jeremiah Louis Bryant |
First Address | Atlanta, GA 30322-0001 |
Second Address | Atlanta, GA 30322 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/11/2012 |
Last Update Date | 01/07/2018 |