Provider Demographics
NPI:1871582015
Name:BRAWNER, PATRICIA SPARKS (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:SPARKS
Last Name:BRAWNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 SO. LUMPKIN ST.
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30606
Mailing Address - Country:US
Mailing Address - Phone:706-552-2820
Mailing Address - Fax:706-354-8904
Practice Address - Street 1:1751 SO. LUMPKIN ST.
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30606
Practice Address - Country:US
Practice Address - Phone:706-552-2820
Practice Address - Fax:706-354-8904
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1719103TC1900X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00624753BMedicaid
GA00624753BMedicaid