Provider Demographics
NPI:1326694084
Name:BOLLING, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BOLLING
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 1:2766 DA VINCI BLVD
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-3116
Mailing Address - Country:US
Mailing Address - Phone:404-804-7235
Mailing Address - Fax:
Practice Address - Street 1:2766 DA VINCI BLVD
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3116
Practice Address - Country:US
Practice Address - Phone:404-804-7235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst