Provider Demographics
NPI:1073795514
Name:BRANNON, JULIA M (PHD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:M
Last Name:BRANNON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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 1:1305 COACH RD STE A
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:336-349-5553
Practice Address - Fax:336-349-5554
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1396103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6000093Medicaid
NC6000093Medicaid