Provider Demographics
NPI:1528060803
Name:BRANDON, NATHAN H (MD)
Entity type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:H
Last Name:BRANDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 PONDER PLACE DR
Mailing Address - Street 2:SUITE 2
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3194
Mailing Address - Country:US
Mailing Address - Phone:706-364-2980
Mailing Address - Fax:706-364-2982
Practice Address - Street 1:621 PONDER PLACE DR
Practice Address - Street 2:SUITE 2
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3194
Practice Address - Country:US
Practice Address - Phone:706-364-2980
Practice Address - Fax:706-364-2982
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-01
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA039536207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA05BDJZCMedicare PIN
GAG05377Medicare UPIN