Healthcare Provider Details

I. General information

NPI: 1164349395
Provider Name (Legal Business Name): CONCIERGE SPORTS AND FAMILY MEDICINE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11680 GREAT OAKS WAY STE 340
ALPHARETTA GA
30022-2457
US

IV. Provider business mailing address

11680 GREAT OAKS WAY STE 340
ALPHARETTA GA
30022-2457
US

V. Phone/Fax

Practice location:
  • Phone: 404-282-9202
  • Fax: 404-282-9203
Mailing address:
  • Phone: 404-282-9202
  • Fax: 404-282-9203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON ARTHUR MINES
Title or Position: OWNER
Credential: MD
Phone: 404-290-8024