Provider Demographics
NPI:1558952176
Name:BRYANT, FELICIA A (HOME HEALTH CARE)
Entity Type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:A
Last Name:BRYANT
Suffix:
Gender:F
Credentials:HOME HEALTH CARE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2565 ELKHORN DR
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30034-2721
Mailing Address - Country:US
Mailing Address - Phone:470-214-1720
Mailing Address - Fax:
Practice Address - Street 1:2565 ELKHORN DRIVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30034-3003
Practice Address - Country:US
Practice Address - Phone:229-234-0062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-27
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA310400000X, 343900000X, 3747P1801X
251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA15558952176Medicaid
GA1558952176Medicaid
GA1558952176OtherHOME HEALTH CARE