Provider Demographics
NPI:1003899634
Name:JULIA BRANNON PHD & ASSOCIATES INCORPORATED
Entity Type:Organization
Organization Name:JULIA BRANNON PHD & ASSOCIATES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:BRANNON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:336-349-5553
Mailing Address - Street 1:546 SANDY CROSS RD
Mailing Address - Street 2:
Mailing Address - City:REIDSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27320-5571
Mailing Address - Country:US
Mailing Address - Phone:336-951-0000
Mailing Address - Fax:336-951-0002
Practice Address - Street 1:546 SANDY CROSS RD
Practice Address - Street 2:
Practice Address - City:REIDSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27320-5571
Practice Address - Country:US
Practice Address - Phone:336-951-0000
Practice Address - Fax:336-951-0002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-29
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1396103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000093Medicaid
NC6000093Medicaid