Provider Demographics
NPI:1477121739
Name:BRYAN, SARON
Entity Type:Individual
Prefix:
First Name:SARON
Middle Name:
Last Name:BRYAN
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 1:2350 PRINCE AVE STE 17
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606-6040
Mailing Address - Country:US
Mailing Address - Phone:706-389-8161
Mailing Address - Fax:888-640-1360
Practice Address - Street 1:2350 PRINCE AVE STE 17
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606-6040
Practice Address - Country:US
Practice Address - Phone:706-389-8161
Practice Address - Fax:888-640-1360
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical