Provider Demographics
NPI:1609005198
Name:BRANNON, PRECIOUS A (PHD)
Entity Type:Individual
Prefix:DR
First Name:PRECIOUS
Middle Name:A
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 1:3918 DUNAIRE DR
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30083-4400
Mailing Address - Country:US
Mailing Address - Phone:404-883-3244
Mailing Address - Fax:
Practice Address - Street 1:3918 DUNAIRE DR
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30083-4400
Practice Address - Country:US
Practice Address - Phone:404-883-3244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-07
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No171W00000XOther Service ProvidersContractor