Provider Demographics
NPI:1528006608
Name:NOBLE, BRANDIE KINNEY (MSPT)
Entity Type:Individual
Prefix:
First Name:BRANDIE
Middle Name:KINNEY
Last Name:NOBLE
Suffix:
Gender:F
Credentials:MSPT
Other - Prefix:
Other - First Name:BRANDIE
Other - Middle Name:
Other - Last Name:KINNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:900 CIRCLE 75 PKWY SE
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30339-3035
Mailing Address - Country:US
Mailing Address - Phone:770-953-6929
Mailing Address - Fax:770-953-6972
Practice Address - Street 1:5205 STILESBORO RD NW
Practice Address - Street 2:BUILDING II, SUITE 200
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-7764
Practice Address - Country:US
Practice Address - Phone:770-218-8800
Practice Address - Fax:770-218-8811
Is Sole Proprietor?:No
Enumeration Date:2006-06-02
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPT8286225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA345587121AMedicaid
GA390126OtherBCBSGA
GA345587121BMedicaid
GA345587121BMedicaid