Healthcare Provider Details

I. General information

NPI: 1558894535
Provider Name (Legal Business Name): BRANDON MAISEL RAMOS D.O
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1265 HIGHWAY 54 W STE 200
FAYETTEVILLE GA
30214-4543
US

IV. Provider business mailing address

275 INTERSTATE NORTH CIR SE STE 500
ATLANTA GA
30339-2565
US

V. Phone/Fax

Practice location:
  • Phone: 770-460-1900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberOS18961
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: