Provider Demographics
NPI:1164608170
Name:BRYANT, AMY C (EDS)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:BRYANT
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1335 N CROSSING DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3570
Mailing Address - Country:US
Mailing Address - Phone:678-886-4907
Mailing Address - Fax:
Practice Address - Street 1:15 LENOX POINTE NE
Practice Address - Street 2:SUITE B
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-7415
Practice Address - Country:US
Practice Address - Phone:404-954-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-21
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health