MEDICARE: LEE BRIAN BRANDT JR. PA

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	363AM0700X	Medical Physician Assistant	003438	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1609840511
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE BRIAN BRANDT JR. PA

Provider Business Mailing Address
First Line	:	5665 NEW NORTHSIDE DR
Second Line	:	SUITE 320
City	:	ATLANTA
State	:	GA
Zip	:	30328-5831
Country	:	US
Telephone Number	:	404-645-7564
Fax Number	:

Provider Business Practice Location Address
First Line	:	4900 IVEY RD NW
Second Line	:	SUITE 1826
City	:	ACWORTH
State	:	GA
Zip	:	30101-4001
Country	:	US
Telephone Number	:	770-975-9077
Fax Number	:	770-790-4964

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

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	04/23/2015

Similar Medicare Providers

1053276683 — LINDSEY CATHERINE WHITE
Practice Location Address:

4900 IVEY RD NW STE 1626
ACWORTH, GA
30101-4001

Practice Phone: 470-531-0510
Practice Fax:

1215887963 — TREASURE LONE
Practice Location Address:

4900 IVEY RD NW STE 1626
ACWORTH, GA
30101-4001

Practice Phone: 470-531-0510
Practice Fax:

1639029218 — KOURTNEY KEMP
Practice Location Address:

4900 IVEY RD NW STE 1626
ACWORTH, GA
30101-4001

Practice Phone: 470-531-0510
Practice Fax:

1689605958 — TYE MARR PT
Practice Location Address:

4900 IVEY RD NW , SUITE 1001
ACWORTH, GA
30101-4001

Practice Phone: 770-917-0924
Practice Fax: 770-917-0926

1992886667 — RUSSELL FRANKLIN PRUITT M.D.
Practice Location Address:

4900 IVEY RD NW BLDG 1000 , SUITE 1025
ACWORTH, GA
30101-4001

Practice Phone: 770-917-9557
Practice Fax: 770-917-9558

1245319516 — JOHN N MURIMI MD
Practice Location Address:

4900 IVEY RD NW , SUITE 1301
ACWORTH, GA
30101-4001

Practice Phone: 770-974-4655
Practice Fax: 770-974-1970

Directions to “ LEE BRIAN BRANDT JR. PA” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.