Provider Demographics
NPI:1740082932
Name:BRYAN, BRIANNA GRACE
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:GRACE
Last Name:BRYAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 COLUMBIA RD
Mailing Address - Street 2:
Mailing Address - City:EDGEFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29824-1225
Mailing Address - Country:US
Mailing Address - Phone:864-554-2835
Mailing Address - Fax:
Practice Address - Street 1:3633 WHEELER RD STE 320
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-6552
Practice Address - Country:US
Practice Address - Phone:706-817-4149
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARBT-25-410580106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst