Provider Demographics
NPI:1700382884
Name:BRYANT, EBONEE PATRICE
Entity Type:Individual
Prefix:
First Name:EBONEE
Middle Name:PATRICE
Last Name:BRYANT
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 1:6586 PATRIOT DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-4469
Mailing Address - Country:US
Mailing Address - Phone:706-593-2486
Mailing Address - Fax:
Practice Address - Street 1:6586 PATRIOT DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-4469
Practice Address - Country:US
Practice Address - Phone:706-593-2486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-05
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician