Healthcare Provider Details

I. General information

NPI: 1285980862
Provider Name (Legal Business Name): BRANDON JEREMY REGISTER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2012
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1020 BARBER CREEK DRIVE SUITE 113, UNIT 6
WATKINSVILLE GA
30677
US

IV. Provider business mailing address

650 JACKSON BRIDGE RD
CANON GA
30520-1610
US

V. Phone/Fax

Practice location:
  • Phone: 706-248-1524
  • Fax: 800-949-8404
Mailing address:
  • Phone: 706-248-1524
  • Fax: 800-949-8404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY003591
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: