Healthcare Provider Details

I. General information

NPI: 1376343699
Provider Name (Legal Business Name): BLUE EPIPHANIES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2025
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5887 GLENRIDGE DR STE 230
SANDY SPRINGS GA
30328-9929
US

IV. Provider business mailing address

1686 DUNTON GREEN WAY
LAWRENCEVILLE GA
30043-7531
US

V. Phone/Fax

Practice location:
  • Phone: 470-207-2410
  • Fax:
Mailing address:
  • Phone: 470-207-2410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. BRANDON LANDRY
Title or Position: CLINICAL PSYCHOLOGIST, OWNER
Credential: PSY.D.
Phone: 470-207-2410