Provider Demographics
NPI:1619598505
Name:SMITH, BRANDON T (MD)
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:T
Last Name:SMITH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1401 DRESDEN DR NE
Mailing Address - Street 2:
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3579
Mailing Address - Country:US
Mailing Address - Phone:404-814-9808
Mailing Address - Fax:404-814-6086
Practice Address - Street 1:1401 DRESDEN DR NE
Practice Address - Street 2:
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30319-3579
Practice Address - Country:US
Practice Address - Phone:404-814-9808
Practice Address - Fax:404-814-6086
Is Sole Proprietor?:No
Enumeration Date:2020-05-01
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR78072207R00000X
GA95987207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine