Provider Demographics
NPI:1548650302
Name:BOGGESS, BRANDON WOODROW (LMSW)
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:WOODROW
Last Name:BOGGESS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 POINT NORTH PL
Mailing Address - Street 2:SUITE 6
Mailing Address - City:DALTON
Mailing Address - State:GA
Mailing Address - Zip Code:30720-2654
Mailing Address - Country:US
Mailing Address - Phone:706-529-6647
Mailing Address - Fax:706-529-9091
Practice Address - Street 1:311 POINT NORTH PL
Practice Address - Street 2:SUITE 6
Practice Address - City:DALTON
Practice Address - State:GA
Practice Address - Zip Code:30720-2654
Practice Address - Country:US
Practice Address - Phone:706-529-6647
Practice Address - Fax:706-529-9091
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAMSW006777104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker