Healthcare Provider Details

I. General information

NPI: 1598229569
Provider Name (Legal Business Name): MICHAEL J BRANNEN JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2019
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BULL ST STE 200
SAVANNAH GA
31401-3378
US

IV. Provider business mailing address

600 E OGLETHORPE HWY STE B
HINESVILLE GA
31313-2988
US

V. Phone/Fax

Practice location:
  • Phone: 855-832-6727
  • Fax: 772-675-9100
Mailing address:
  • Phone: 407-907-2077
  • Fax: 973-888-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: