MEDICARE: BRANDON RENFROE

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	2713	TN
2	363A00000X	Physician Assistant	10183	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427449610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON RENFROE

Provider Business Mailing Address
First Line	:	1635 DUNRAVEN DR
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37922-7306
Country	:	US
Telephone Number	:	239-771-2787
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 HIXSON PIKE
Second Line	:
City	:	HIXSON
State	:	TN
Zip	:	37343-5726
Country	:	US
Telephone Number	:	423-414-1464
Fax Number	:

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

Provider Enumeration Date	:	02/10/2015
Last Update Date	:	03/13/2026

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Directions to “ BRANDON RENFROE ” Practice Location

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