Provider Demographics
NPI:1861269391
Name:GRIGGS, BRYCE
Entity type:Individual
Prefix:
First Name:BRYCE
Middle Name:
Last Name:GRIGGS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 CORVETTE ST
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8733
Mailing Address - Country:US
Mailing Address - Phone:912-414-7487
Mailing Address - Fax:
Practice Address - Street 1:327 DAHLONEGA ST STE A1901
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-8220
Practice Address - Country:US
Practice Address - Phone:678-549-6935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-05
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC010306101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional