Provider Demographics
NPI:1992252753
Name:BRYAN, TRACI HUNTER (PHARMD)
Entity type:Individual
Prefix:MRS
First Name:TRACI
Middle Name:HUNTER
Last Name:BRYAN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 MILSTEAD AVE NE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CONYERS
Mailing Address - State:GA
Mailing Address - Zip Code:30012
Mailing Address - Country:US
Mailing Address - Phone:770-760-9949
Mailing Address - Fax:
Practice Address - Street 1:1501 MILSTEAD AVE NE
Practice Address - Street 2:SUITE 110
Practice Address - City:CONYERS
Practice Address - State:GA
Practice Address - Zip Code:30012
Practice Address - Country:US
Practice Address - Phone:770-760-9949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-08
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH021491183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist