Provider Demographics
NPI:1740355288
Name:HIEGER, BRADLEY (PHD, LPC)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:
Last Name:HIEGER
Suffix:
Gender:M
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5975 PARKWAY NORTH BLVD
Mailing Address - Street 2:SUITE 300 D
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-1226
Mailing Address - Country:US
Mailing Address - Phone:404-388-3909
Mailing Address - Fax:678-712-1945
Practice Address - Street 1:5975 PARKWAY NORTH BLVD
Practice Address - Street 2:SUITE 300 D
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-1226
Practice Address - Country:US
Practice Address - Phone:404-388-3909
Practice Address - Fax:678-712-1945
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005028101YM0800X
GAPSY003603103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA883083592AMedicaid