Ivory Myrick Bryant, M.S., CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP006196 Issued in GA

Practice address

545 Old Norcross Rd
Suite 100
Lawrenceville, GA 30046-3389

Phone

(678) 377-2833

Fax

(678) 377-2882

NPI assigned

Aug 19, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Miss Ivory Eugene Myrick Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124409600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1302048000000",
    "number": "1104818764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "545 OLD NORCROSS RD",
            "address_2": "SUITE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463389",
            "telephone_number": "678-377-2833",
            "fax_number": "678-377-2882"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "545 OLD NORCROSS RD",
            "address_2": "SUITE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300463389",
            "telephone_number": "678-377-2833",
            "fax_number": "678-377-2882"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRYANT",
        "first_name": "IVORY",
        "middle_name": "MYRICK",
        "name_prefix": "Mrs.",
        "credential": "M.S., CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-08-19",
        "last_updated": "2011-04-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP006196",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ACTIVE MEDICAID",
            "identifier": "392229867A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IVORY",
            "last_name": "MYRICK",
            "middle_name": "EUGENE",
            "prefix": "MISS",
            "credential": "M.S. CCC-SLP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Craigh Keith Bryan, MD
• Shawneka D Bryan, NP-C
• Alyssa Renee Bryant, M.D.
• Carlton Reece Bryant
• Claudette Bryant, PA
• Marcia Bryant
• Kunal B Buch, M.D.
• Stacy B Buchanan, RN, MS, CPNP
• Thyra Isela Buchanan, FNP-BC
• Buckhead Psychiatry Services, LLC

• Speech-Language Pathologist in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.