Healthcare Provider Details

I. General information

NPI: 1902549108
Provider Name (Legal Business Name): BARBARA BRAHMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 04/15/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 MARKS CHURCH RD
AUGUSTA GA
30909-2670
US

IV. Provider business mailing address

606 HIGHVIEW CIR
GROVETOWN GA
30813-4709
US

V. Phone/Fax

Practice location:
  • Phone: 706-868-5011
  • Fax:
Mailing address:
  • Phone: 407-221-1162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: