Provider Demographics
NPI:1952636953
Name:RYLAND, ELIZABETH BANKS (PHD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:BANKS
Last Name:RYLAND
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 HAMPTON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31520-4252
Mailing Address - Country:US
Mailing Address - Phone:912-264-9724
Mailing Address - Fax:912-264-4071
Practice Address - Street 1:3226 HAMPTON AVE STE F
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31520-4252
Practice Address - Country:US
Practice Address - Phone:912-264-9724
Practice Address - Fax:912-264-4071
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001819103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist