Provider Demographics
NPI:1881013621
Name:ROBIN A. BRILL, PHD,LLC
Entity Type:Organization
Organization Name:ROBIN A. BRILL, PHD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRILL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:770-886-8488
Mailing Address - Street 1:5807 LONG PARK RD
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-5718
Mailing Address - Country:US
Mailing Address - Phone:770-886-8488
Mailing Address - Fax:
Practice Address - Street 1:5807 LONG PARK RD
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-5718
Practice Address - Country:US
Practice Address - Phone:770-886-8488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-09
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY002263103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00821906Medicaid