MEDICARE: DR. DREW R BRANNON PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	1194	SC

General Provider Information

NPI Number	:	1104107267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DREW R BRANNON PH.D.

Provider Business Mailing Address
First Line	:	86 VILLA RD
Second Line	:	SUITE B
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3052
Country	:	US
Telephone Number	:	864-239-4110
Fax Number	:	864-242-9808

Provider Business Practice Location Address
First Line	:	86 VILLA RD
Second Line	:	SUITE B
City	:	GREENVILLE
State	:	SC
Zip	:	29615-3052
Country	:	US
Telephone Number	:	864-239-4110
Fax Number	:	864-242-9808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/02/2011
Last Update Date	:	09/02/2011

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