Provider Demographics
NPI:1104490903
Name:BRYANT, EMILY SHAY (PHD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:SHAY
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 PIEDMONT RD NE STE 740
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1507
Mailing Address - Country:US
Mailing Address - Phone:404-875-2050
Mailing Address - Fax:
Practice Address - Street 1:3500 PIEDMONT RD NE STE 740
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1507
Practice Address - Country:US
Practice Address - Phone:404-875-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-17
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4141103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical