Healthcare Provider Details

I. General information

NPI: 1013340728
Provider Name (Legal Business Name): BRANDON LEI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/24/2023
Certification Date: 02/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1364 CLIFTON RD NE STE AG05
ATLANTA GA
30322-1018
US

IV. Provider business mailing address

600 PHIPPS BLVD NE APT 2009
ATLANTA GA
30326-3369
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4747
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number96315
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: