Provider Demographics
NPI:1033447313
Name:KING, BRANDON VIRDELL (CSA, CSFA)
Entity Type:Individual
Prefix:MR
First Name:BRANDON
Middle Name:VIRDELL
Last Name:KING
Suffix:
Gender:M
Credentials:CSA, CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 81
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-0081
Mailing Address - Country:US
Mailing Address - Phone:678-517-3428
Mailing Address - Fax:770-485-1534
Practice Address - Street 1:55 ATLANTA ST SE STE 204
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1977
Practice Address - Country:US
Practice Address - Phone:678-517-3428
Practice Address - Fax:770-485-1534
Is Sole Proprietor?:No
Enumeration Date:2009-11-25
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical