Healthcare Provider Details

I. General information

NPI: 1578719159
Provider Name (Legal Business Name): BRANDON HURLEY LAPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 08/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 E DOUGHERTY ST
ATHENS GA
30601-2608
US

IV. Provider business mailing address

250 NORTH AVE
ATHENS GA
30601-2244
US

V. Phone/Fax

Practice location:
  • Phone: 706-542-9700
  • Fax: 706-227-7249
Mailing address:
  • Phone: 706-542-9700
  • Fax: 706-227-7249

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberAPC001926
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: