Provider Demographics
NPI:1225331606
Name:BRUNER, JOHN MARSHALL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MARSHALL
Last Name:BRUNER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 ELEPHANT TRL
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3016
Mailing Address - Country:US
Mailing Address - Phone:404-734-2186
Mailing Address - Fax:
Practice Address - Street 1:7200 SILK TREE POINTE
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-3458
Practice Address - Country:US
Practice Address - Phone:404-734-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-07
Last Update Date:2015-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY3449103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist