Provider Demographics
NPI:1154363927
Name:BRYAN MEDICAL ASSOCIATES,INC
Entity type:Organization
Organization Name:BRYAN MEDICAL ASSOCIATES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER / BILLER DEPT
Authorized Official - Prefix:
Authorized Official - First Name:CONNIELYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:912-876-5452
Mailing Address - Street 1:740 E GENERAL STEWART WAY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:HINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31313-2634
Mailing Address - Country:US
Mailing Address - Phone:912-876-5452
Mailing Address - Fax:
Practice Address - Street 1:740 E GENERAL STEWART WAY
Practice Address - Street 2:SUITE 103
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-2634
Practice Address - Country:US
Practice Address - Phone:912-876-5452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG035674Medicare UPIN
GA11SCDXHMedicare ID - Type Unspecified