Provider Demographics
NPI:1952618423
Name:BRANNON, PATRICIA ANN (LICENSED CHRISTIAN C)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:ANN
Last Name:BRANNON
Suffix:
Gender:F
Credentials:LICENSED CHRISTIAN C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 MORNING CREEK LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-3790
Mailing Address - Country:US
Mailing Address - Phone:404-723-8667
Mailing Address - Fax:770-274-1020
Practice Address - Street 1:5976 PEACHTREE RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341
Practice Address - Country:US
Practice Address - Phone:770-274-1010
Practice Address - Fax:770-274-1020
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-07
Last Update Date:2010-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03983449101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor