Healthcare Provider Details

I. General information

NPI: 1427150150
Provider Name (Legal Business Name): BRANDON A MINES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 PACES FERRY RD SE STE 500
ATLANTA GA
30339-5714
US

IV. Provider business mailing address

4300 PACES FERRY RD SE STE 500
ATLANTA GA
30339-5714
US

V. Phone/Fax

Practice location:
  • Phone: 42-829-2024
  • 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 Number56325
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number332488
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number56325
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: