Provider Demographics
NPI:1346070463
Name:FAIETA, BRANDON WILLIAM (DC)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:WILLIAM
Last Name:FAIETA
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5422 CUMMING HWY # 20
Mailing Address - Street 2:
Mailing Address - City:SUGAR HILL
Mailing Address - State:GA
Mailing Address - Zip Code:30518-7027
Mailing Address - Country:US
Mailing Address - Phone:678-482-4400
Mailing Address - Fax:
Practice Address - Street 1:5422 CUMMING HWY # 20
Practice Address - Street 2:
Practice Address - City:SUGAR HILL
Practice Address - State:GA
Practice Address - Zip Code:30518-7027
Practice Address - Country:US
Practice Address - Phone:678-482-4400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-05
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACHIR010433111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor