Provider Demographics
NPI:1578224879
Name:KRONEMBERG, THOMAS BRANDON (MS, APC)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:BRANDON
Last Name:KRONEMBERG
Suffix:
Gender:M
Credentials:MS, APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4330 S LEE ST STE 600-A
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30518-3072
Mailing Address - Country:US
Mailing Address - Phone:770-725-3505
Mailing Address - Fax:470-466-0500
Practice Address - Street 1:4330 S LEE ST STE 600-A
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30518-3072
Practice Address - Country:US
Practice Address - Phone:770-725-3505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007907101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor