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General NPI Number Information
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NPI Number | 1982579108
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Entity Type | Individual
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Provider Name | BRANDON KENNETH MAHONE DPT
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Gender | Male
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Dates
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Enumeration Date | 10/07/2025
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 620 CHEROKEE ST NE STE 300
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City | MARIETTA
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State | GA
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Zip | 30060-7233
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Country | US
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Telephone | 770-635-1812
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Fax |
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Provider Business Mailing Address
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Address Line | 3100 INTERSTATE NORTH CIR SE STE 500
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City | ATLANTA
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State | GA
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Zip | 30339-2296
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Country | US
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Telephone | 678-996-7230
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Fax |
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT018066
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License Number State | GA
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