Provider Demographics
NPI:1356492128
Name:RUSSELL E. BROOKER, ED.D., P.C.
Entity Type:Organization
Organization Name:RUSSELL E. BROOKER, ED.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:BROOKER
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:404-873-6178
Mailing Address - Street 1:181 14TH ST NE
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-3674
Mailing Address - Country:US
Mailing Address - Phone:404-873-6178
Mailing Address - Fax:404-873-0342
Practice Address - Street 1:181 14TH ST NE
Practice Address - Street 2:SUITE 450
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-3674
Practice Address - Country:US
Practice Address - Phone:404-873-6178
Practice Address - Fax:404-873-0342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA360103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty