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General NPI Number Information
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NPI Number | 1285097964
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Entity Type | Individual
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Provider Name | KELLY O'BRYANT LMSW
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Gender | Female
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Dates
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Enumeration Date | 03/31/2016
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Last Update Date | 03/31/2016
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Provider Practice Location Address
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Address Line | 501 MIZE ST
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City | LA FAYETTE
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State | GA
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Zip | 30728-3346
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Country | US
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Telephone | 706-956-5526
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1027
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City | LA FAYETTE
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State | GA
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Zip | 30728-1027
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Country | US
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Telephone | 706-956-5526
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | MSW007078
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License Number State | GA
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