Provider Demographics
NPI:1053407254
Name:BROOKS, MARK A (PHD)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:A
Last Name:BROOKS
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Gender:M
Credentials:PHD
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Mailing Address - Street 1:1708 PEACHTREE ST NW
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-2434
Mailing Address - Country:US
Mailing Address - Phone:404-607-1220
Mailing Address - Fax:404-607-1240
Practice Address - Street 1:1708 PEACHTREE ST NW
Practice Address - Street 2:SUITE 400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-2434
Practice Address - Country:US
Practice Address - Phone:404-607-1220
Practice Address - Fax:404-607-1240
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GAPSY001250103G00000X
FLPSY7294103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist