Provider Demographics
NPI:1093388779
Name:WITZMAN, BRYN TAYLOR (AUD)
Entity Type:Individual
Prefix:DR
First Name:BRYN
Middle Name:TAYLOR
Last Name:WITZMAN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:DR
Other - First Name:BRYN
Other - Middle Name:TAYLOR
Other - Last Name:POND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2301 NEWNAN CROSSING BLVD E STE 160
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2576
Mailing Address - Country:US
Mailing Address - Phone:770-254-2224
Mailing Address - Fax:770-254-2225
Practice Address - Street 1:2301 NEWNAN CROSSING BLVD E STE 160
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2576
Practice Address - Country:US
Practice Address - Phone:770-254-2224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-21
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAUD004293237600000X, 231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAAUD004293OtherGEORGIA AUDIOLOGY LICENSE