Provider Demographics
NPI:1083498471
Name:BRYANT, YOLANDO
Entity Type:Individual
Prefix:MS
First Name:YOLANDO
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CHEROKEE AVE
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:GA
Mailing Address - Zip Code:31763-4766
Mailing Address - Country:US
Mailing Address - Phone:229-291-6895
Mailing Address - Fax:
Practice Address - Street 1:111 CHEROKEE AVE
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:GA
Practice Address - Zip Code:31763-4766
Practice Address - Country:US
Practice Address - Phone:229-291-6895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-24
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator