Provider Demographics
NPI:1285632190
Name:SANDIFER, BRETT L (MD)
Entity Type:Individual
Prefix:DR
First Name:BRETT
Middle Name:L
Last Name:SANDIFER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1968 PEACHTREE RD NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1281
Mailing Address - Country:US
Mailing Address - Phone:770-948-5409
Mailing Address - Fax:770-948-7994
Practice Address - Street 1:3820 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-1110
Practice Address - Country:US
Practice Address - Phone:770-948-6041
Practice Address - Fax:770-739-5411
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2015-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA051381207RP1001X, 207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
I28790Medicare UPIN
29BDCLRMedicare UPIN
GA202I296643Medicare PIN
GA012852850EMedicaid