Provider Demographics
NPI:1639552516
Name:BRYANT, KELLY DAWN (MS, RDN, LD)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:DAWN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MS, RDN, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2785 BUFORD HWY
Mailing Address - Street 2:SUITE 102B
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-2800
Mailing Address - Country:US
Mailing Address - Phone:706-207-6922
Mailing Address - Fax:
Practice Address - Street 1:2785 BUFORD HWY
Practice Address - Street 2:SUITE 102B
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-2800
Practice Address - Country:US
Practice Address - Phone:706-207-6922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA002462133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered