Healthcare Provider Details

I. General information

NPI: 1295657815
Provider Name (Legal Business Name): BRANDON HEATH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 MAIN ST
WARRENTON GA
30828-8308
US

IV. Provider business mailing address

6005 REYNOLDS CIR
GROVETOWN GA
30813-1257
US

V. Phone/Fax

Practice location:
  • Phone: 706-465-1188
  • Fax:
Mailing address:
  • Phone: 706-830-4945
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: