MEDICARE: BRANDI TANKS LMT, RMT,MMP, MBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	171400000X	Health & Wellness Coach
2	173C00000X	Reflexologist	GA
3	291U00000X	Clinical Medical Laboratory
4	246RM2200X	Medical Laboratory Technician
5	101YP1600X	Pastoral Counselor	GA

General Provider Information

NPI Number	:	1457812984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDI TANKS LMT, RMT,MMP, MBA

Provider Business Mailing Address
First Line	:	2625 SANDY PLAINS RD STE 103
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-4290
Country	:	US
Telephone Number	:	470-787-2546
Fax Number	:	470-878-2536

Provider Business Practice Location Address
First Line	:	2625 SANDY PLAINS RD STE 103
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30066-4290
Country	:	US
Telephone Number	:	470-787-2546
Fax Number	:	470-878-2536

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2019
Last Update Date	:	05/08/2026

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