Individual
MRS. IVORY MYRICK BRYANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
545 OLD NORCROSS RD, SUITE 100, LAWRENCEVILLE, GA 30046-3389
(678) 377-2833
(678) 377-2882
Mailing address
545 OLD NORCROSS RD, SUITE 100, LAWRENCEVILLE, GA 30046-3389
(678) 377-2833
(678) 377-2882
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP006196
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
392229867A
ACTIVE MEDICAID
GA
Enumeration date
08/19/2005
Last updated
04/06/2011
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