Healthcare Provider Details

I. General information

NPI: 1558952176
Provider Name (Legal Business Name): FELICIA A BRYANT HOME HEALTH CARE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2021
Last Update Date: 02/25/2021
Certification Date: 02/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2565 ELKHORN DRIVE
DECATUR GA
30034-3003
US

IV. Provider business mailing address

2565 ELKHORN DR
DECATUR GA
30034-2721
US

V. Phone/Fax

Practice location:
  • Phone: 229-234-0062
  • Fax:
Mailing address:
  • Phone: 470-214-1720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: