Provider Demographics
NPI:1568279123
Name:BRYANT, MARIAH RAYCAL
Entity type:Individual
Prefix:
First Name:MARIAH
Middle Name:RAYCAL
Last Name:BRYANT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7307 MONASTERY RD
Mailing Address - Street 2:
Mailing Address - City:FAIRBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30213-3201
Mailing Address - Country:US
Mailing Address - Phone:470-301-4584
Mailing Address - Fax:
Practice Address - Street 1:7307 MONASTERY RD
Practice Address - Street 2:
Practice Address - City:FAIRBURN
Practice Address - State:GA
Practice Address - Zip Code:30213-3201
Practice Address - Country:US
Practice Address - Phone:470-301-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2024-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician