Provider Demographics
NPI:1063142834
Name:BRYANT, JANAE'
Entity type:Individual
Prefix:
First Name:JANAE'
Middle Name:
Last Name:BRYANT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 WESTVIEW DR SW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30314-3773
Mailing Address - Country:US
Mailing Address - Phone:678-468-1654
Mailing Address - Fax:
Practice Address - Street 1:2505 DALLAS HWY SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-2659
Practice Address - Country:US
Practice Address - Phone:678-956-6230
Practice Address - Fax:678-956-6236
Is Sole Proprietor?:No
Enumeration Date:2022-06-14
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA12144363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program