Healthcare Provider Details

I. General information

NPI: 1083965917
Provider Name (Legal Business Name): BRANDON LEE ESHLEMAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2012
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5009 ROSWELL RD STE 201
ATLANTA GA
30342-2205
US

IV. Provider business mailing address

5009 ROSWELL RD STE 201
ATLANTA GA
30342-2205
US

V. Phone/Fax

Practice location:
  • Phone: 404-264-9553
  • Fax: 404-266-2294
Mailing address:
  • Phone: 404-264-9553
  • Fax: 404-266-2294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number006606
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: