Provider Demographics
NPI:1457456436
Name:RYLES, BRYAN SCOTT (PHD)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:SCOTT
Last Name:RYLES
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 RESEARCH DR STE D
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-2782
Mailing Address - Country:US
Mailing Address - Phone:706-215-9077
Mailing Address - Fax:706-215-9077
Practice Address - Street 1:585 RESEARCH DR STE D
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-2782
Practice Address - Country:US
Practice Address - Phone:706-215-9077
Practice Address - Fax:706-215-9192
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY2565103T00000X
CAPSY15360103TC0700X, 103T00000X
GAPSY002565103TC0700X
CAMFC25135106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAMAGELLAN BEHAVIORALOther294710000
GACIGNA BEHAVIORALOther2104452