=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740566009
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BRIANNA GAYNOR PSY.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2011
-----------------------------------------------------
Last Update Date | 10/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3580 OLD MILTON PKWY
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30005-4465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-667-3565
-----------------------------------------------------
Fax | 404-443-0926
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3580 OLD MILTON PKWY
-----------------------------------------------------
City | ALPHARETTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30005-4465
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-667-3565
-----------------------------------------------------
Fax | 404-443-0926
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | PSY003462
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------