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General NPI Number Information
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NPI Number | 1285980862
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Entity Type | Individual
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Provider Name | BRANDON JEREMY REGISTER PH.D.
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Gender | Male
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Dates
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Enumeration Date | 08/01/2012
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 1020 BARBER CREEK DRIVE SUITE 113, UNIT 6
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City | WATKINSVILLE
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State | GA
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Zip | 30677
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Country | US
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Telephone | 706-248-1524
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Fax | 800-949-8404
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Provider Business Mailing Address
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Address Line | 650 JACKSON BRIDGE RD
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City | CANON
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State | GA
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Zip | 30520-1610
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Country | US
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Telephone | 706-248-1524
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Fax | 800-949-8404
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | PSY003591
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License Number State | GA
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