Elizabeth Gray Bryan
Individual provider Active NPI Physician Assistant · North Augusta, SC
NPI 1215484530 · NPPES record last updated Jan 26, 2017
Key facts
- NPI
- 1215484530
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 2623 (SC)
- Practice address
- 336 Georgia Ave
North Augusta, SC 29841-3849 - Phone
- (803) 553-0327
- NPI assigned
- Sep 2, 2016
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170404000137 | SC | Practitioner - Physician Assistant | 8022392901 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2623 | SC | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Umg Prompt Care LLC | Current |
Accepting new patients | |
| University Prompt Care | Current | Accepting new patients | |
| University Medical Group LLC | Current | Accepting new patients | |
| University Health Care Physicians LLC | Current | Accepting new patients |
Locations
447 N Belair Rd
Ste 101
Evans, GA 30809
Phone (706) 854-2222
325 Georgia Ave
Ste 100
North Augusta, SC 29841
Phone (803) 202-3351
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 2623 | SC | Yes |
Addresses
Primary practice location
336 Georgia Ave
North Augusta, SC 29841-3849
Mailing address
PO Box 1705
Augusta, GA 30903-1705
Phone (706) 854-6917
Other names
- Elizabeth Bragan Gray
Other providers in North Augusta, SC
- Jean Rochelle Brown
- Jeanora Brown
- Karen Brown
- Margery A Brown
- Spechell Brown
- Vickie Lynn Bryan
- Ron E. Bryant
- Yolanda Bryant
- Andrew James Buist
- Robert James Buist
All providers in North Augusta, SC · Physician Assistant in South Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 26, 2017. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.