MEDICARE: TISSILLI BRANDI ROGERS

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	101YM0800X	Mental Health Counselor		GA

General Provider Information

NPI Number	:	1437006442
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TISSILLI BRANDI ROGERS

Provider Business Mailing Address
First Line	:	3558 SAWMILL TER
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30062-4222
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 REFORMATION PKWY
Second Line	:
City	:	CANTON
State	:	GA
Zip	:	30114-2901
Country	:	US
Telephone Number	:	770-345-9535
Fax Number	:

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

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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