Provider Demographics
NPI:1588769178
Name:BRYAN, CRAIGH KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:CRAIGH
Middle Name:KEITH
Last Name:BRYAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1000 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7694
Mailing Address - Country:US
Mailing Address - Phone:678-312-3273
Mailing Address - Fax:678-312-3282
Practice Address - Street 1:1000 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-7694
Practice Address - Country:US
Practice Address - Phone:678-312-1000
Practice Address - Fax:678-312-3282
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY221294207R00000X
GA97672208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2589956OtherGHI
NY2528854OtherUNITED HEALTH
NY02170818Medicaid
NY8577911OtherCIGNA
NYNY221294Other1199 SEIU
NYP3482897OtherOXFORD
NY1391S1OtherEMPIRE BLUE CROSS SHEILD
NYH49227Medicare UPIN
NY1391S1OtherEMPIRE BLUE CROSS SHEILD