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General NPI Number Information
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NPI Number | 1427150150
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Entity Type | Individual
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Provider Name | BRANDON A MINES MD
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Gender | Male
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 10/28/2024
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Provider Practice Location Address
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Address Line | 4300 PACES FERRY RD SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-5714
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Country | US
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Telephone | 42-829-2024
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Fax | 404-282-9203
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Provider Business Mailing Address
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Address Line | 4300 PACES FERRY RD SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-5714
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Country | US
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Telephone | 404-282-9202
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Fax | 404-282-9203
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 56325
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 56325
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License Number State | GA
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