Healthcare Provider Details

I. General information

NPI: 1821140237
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL BROOKS PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 05/08/2023
Certification Date: 05/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3338 TRICKUM ROAD
WOODSTOCK GA
30188-8212
US

IV. Provider business mailing address

3500 DEPAUW BLVD SUITE 3070
INDIANAPOLIS IN
46268-6135
US

V. Phone/Fax

Practice location:
  • Phone: 470-472-0039
  • Fax: 317-520-8200
Mailing address:
  • Phone: 855-324-0885
  • Fax: 317-520-8200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY003769
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: