Provider Demographics
NPI:1942558309
Name:RYAN, CARLY (MD)
Entity type:Individual
Prefix:DR
First Name:CARLY
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:REBECCA
Other - Last Name:WINTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4600 WATERS AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-6274
Mailing Address - Country:US
Mailing Address - Phone:912-355-2462
Mailing Address - Fax:912-353-1836
Practice Address - Street 1:4600 WATERS AVE STE 100
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6274
Practice Address - Country:US
Practice Address - Phone:912-355-2462
Practice Address - Fax:912-353-1836
Is Sole Proprietor?:No
Enumeration Date:2012-08-16
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA05217208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics