Healthcare Provider Details

I. General information

NPI: 1699457051
Provider Name (Legal Business Name): ANDREW JAMES BRYANT RBT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/04/2023
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 GODBY RD
ATLANTA GA
30349-5020
US

IV. Provider business mailing address

3469 ENGLISH OAKS DR NW
KENNESAW GA
30144-6034
US

V. Phone/Fax

Practice location:
  • Phone: 770-524-1473
  • Fax:
Mailing address:
  • Phone: 404-725-8552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-79384
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: