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General NPI Number Information
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NPI Number | 1225331606
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Entity Type | Individual
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Provider Name | JOHN MARSHALL BRUNER PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 12/07/2010
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 7200 SILK TREE POINTE
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City | BRASELTON
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State | GA
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Zip | 30517-3458
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Country | US
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Telephone | 404-734-2186
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Fax |
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Provider Business Mailing Address
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Address Line | 1050 ELEPHANT TRL
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City | GAINESVILLE
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State | GA
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Zip | 30501-3016
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Country | US
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Telephone | 404-734-2186
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY3449
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License Number State | GA
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