Provider Demographics
NPI:1598412348
Name:BRIZENDINE, ROBERT (APC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:BRIZENDINE
Suffix:
Gender:M
Credentials:APC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 NORTHSIDE PARKWAY
Mailing Address - Street 2:BUILDING 14, SUITE 100
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30327
Mailing Address - Country:US
Mailing Address - Phone:706-705-2931
Mailing Address - Fax:
Practice Address - Street 1:4200 NORTHSIDE PARKWAY
Practice Address - Street 2:BUILDING 14, SUITE 100
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30327
Practice Address - Country:US
Practice Address - Phone:706-705-2931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-02
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAPC007747101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor