Provider Demographics
NPI:1316475619
Name:KRYAK, BRANDON ROBERT (PA-C)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:ROBERT
Last Name:KRYAK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1924 PIEDMONT RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4117
Mailing Address - Country:US
Mailing Address - Phone:404-881-0966
Mailing Address - Fax:
Practice Address - Street 1:200 ANDREWS ST STE 100
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-3974
Practice Address - Country:US
Practice Address - Phone:864-295-2131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-31
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
GA8405363AM0700X
SC4916363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical