MEDICARE: MRS. BRANDI MARIE FLEISCHMANN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1596	TN
2	363A00000X	Physician Assistant	10001620A	IN
3	363A00000X	Physician Assistant	PA1835	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1081766	OTHER	TN	NCCPA ID
2	10001620A	OTHER	IN	INDIANA STATE LICENSE
3	PA1835	OTHER	KY	KENTUCKY STATE LICENSE
4	1596	OTHER	TN	TENNESSEE STATE LICENSE NUMBER
5	12511065	OTHER	KY	CAQH

General Provider Information

NPI Number	:	1316104953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BRANDI MARIE FLEISCHMANN PA-C

Provider Business Mailing Address
First Line	:	300 W HOSPITAL RD
Second Line	:
City	:	FORT GORDON
State	:	GA
Zip	:	30905-4470
Country	:	US
Telephone Number	:	706-787-5811
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 W HOSPITAL RD
Second Line	:
City	:	FORT GORDON
State	:	GA
Zip	:	30905-4470
Country	:	US
Telephone Number	:	706-787-5811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/21/2008
Last Update Date	:	06/25/2025

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