Individual
LEE BRIAN BRANDT JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
4900 IVEY RD NW, SUITE 1826, ACWORTH, GA 30101-4001
(770) 975-9077
(770) 790-4964
Mailing address
5665 NEW NORTHSIDE DR, SUITE 320, ATLANTA, GA 30328-5831
(404) 645-7564
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
003438
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100000704C
—
GA
05
—
100000704D
—
GA
05
—
100000704E
—
GA
Enumeration date
02/15/2006
Last updated
04/23/2015
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