Provider Demographics
NPI:1427150150
Name:MINES, BRANDON A (MD)
Entity type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:A
Last Name:MINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4300 PACES FERRY RD SE STE 500
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-5714
Mailing Address - Country:US
Mailing Address - Phone:404-282-9202
Mailing Address - Fax:404-282-9203
Practice Address - Street 1:4300 PACES FERRY RD SE STE 500
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30339-5714
Practice Address - Country:US
Practice Address - Phone:042-829-2024
Practice Address - Fax:404-282-9203
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA56325207Q00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA563255OtherPHYSICIAN DICTATION#