Healthcare Provider Details

I. General information

NPI: 1003569989
Provider Name (Legal Business Name): BRANDON LANDRY PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2022
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: 239-247-4699
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY61652280
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY004572
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: