Basic Information
Provider Information
NPI: 1003150871
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRYANT
FirstName: JEREMIAH
MiddleName: LOUIS
NamePrefix: MR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3B SOUTH EMORY UNIVERSITY HOSPITAL 1364 CLIFTON ROAD NE
Address2:  
City: ATLANTA
State: GA
PostalCode: 303220001
CountryCode: US
TelephoneNumber: 8007115444
FaxNumber: 4047785405
Practice Location
Address1: 3B SOUTH EMORY UNIVERSITY HOSPITAL 1364 CLIFTON ROAD NE
Address2:  
City: ATLANTA
State: GA
PostalCode: 30322
CountryCode: US
TelephoneNumber: 8007115444
FaxNumber: 4047785405
Other Information
ProviderEnumerationDate: 11/19/2012
LastUpdateDate: 07/01/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X010114GAY Allopathic & Osteopathic PhysiciansAnesthesiology 
390200000X  N Student, Health CareStudent in an Organized Health Care Education/Training Program 

No ID Information.


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