Provider Demographics
NPI:1902976491
Name:BRANDIS, ALAN D (PHD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:D
Last Name:BRANDIS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2520 WINDY HILL RD SE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-8664
Mailing Address - Country:US
Mailing Address - Phone:770-953-6401
Mailing Address - Fax:770-953-6015
Practice Address - Street 1:2520 WINDY HILL RD SE
Practice Address - Street 2:SUITE 203
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8664
Practice Address - Country:US
Practice Address - Phone:770-953-6401
Practice Address - Fax:770-953-6015
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPSY001906103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000662703BMedicaid
GA000662703FMedicaid
GA000662703FMedicaid