Provider Demographics
NPI:1235919390
Name:HEREMAN, BRANDON (PA)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:
Last Name:HEREMAN
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 AVONDALE CREEK DR UNIT 423
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-8418
Mailing Address - Country:US
Mailing Address - Phone:407-443-2808
Mailing Address - Fax:
Practice Address - Street 1:965 OAKLAND RD STE C
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30044-3758
Practice Address - Country:US
Practice Address - Phone:678-364-2210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-04
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical