=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760392013
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PRESLEY BRYAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2026
-----------------------------------------------------
Last Update Date | 09/09/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 GEORGIAN PARK STE 220
-----------------------------------------------------
City | PEACHTREE CITY
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30269-6974
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-438-1265
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5881 REINHARDT COLLEGE PKWY
-----------------------------------------------------
City | WALESKA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30183-3613
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106E00000X
-----------------------------------------------------
Taxonomy Name | Assistant Behavior Analyst
-----------------------------------------------------
License Number | LABA000062
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------