Provider Demographics
NPI:1285980862
Name:REGISTER, BRANDON JEREMY (PHD)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:JEREMY
Last Name:REGISTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 JACKSON BRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:CANON
Mailing Address - State:GA
Mailing Address - Zip Code:30520-1610
Mailing Address - Country:US
Mailing Address - Phone:706-248-1524
Mailing Address - Fax:800-949-8404
Practice Address - Street 1:1020 BARBER CREEK DRIVE
Practice Address - Street 2:SUITE 113, UNIT 6
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677
Practice Address - Country:US
Practice Address - Phone:706-248-1524
Practice Address - Fax:800-949-8404
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003591103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling