Provider Demographics
NPI:1922273358
Name:BRESHEARS, RYAN EDWARD (PHD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:EDWARD
Last Name:BRESHEARS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:55 WHITCHER ST NE
Mailing Address - Street 2:SUITE 420
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30060-1155
Mailing Address - Country:US
Mailing Address - Phone:770-514-6760
Mailing Address - Fax:770-794-8034
Practice Address - Street 1:55 WHITCHER ST NE
Practice Address - Street 2:SUITE 420
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1155
Practice Address - Country:US
Practice Address - Phone:770-514-6760
Practice Address - Fax:770-794-8034
Is Sole Proprietor?:No
Enumeration Date:2008-04-27
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPSY003306OtherGA LICENSE #