Healthcare Provider Details

I. General information

NPI: 1528060803
Provider Name (Legal Business Name): NATHAN H BRANDON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 02/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 PONDER PLACE DR SUITE 2
EVANS GA
30809-3194
US

IV. Provider business mailing address

621 PONDER PLACE DR SUITE 2
EVANS GA
30809-3194
US

V. Phone/Fax

Practice location:
  • Phone: 706-364-2980
  • Fax: 706-364-2982
Mailing address:
  • Phone: 706-364-2980
  • Fax: 706-364-2982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number039536
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: