Healthcare Provider Details

I. General information

NPI: 1275963001
Provider Name (Legal Business Name): KIMBERLY MICHELLE BRYANT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2013
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 GOVERNORS SQ STE D
PEACHTREE CITY GA
30269-4871
US

IV. Provider business mailing address

4800 N SCOTTSDALE RD STE 2500
SCOTTSDALE AZ
85251-7630
US

V. Phone/Fax

Practice location:
  • Phone: 678-423-5500
  • Fax: 678-271-3204
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW004616
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: