Brandon Medical Group PLLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

DO212 Issued in TN

Legal business name

BRANDON MEDICAL GROUP PLLC

Practice address

482 Interstate Dr Ste a
Manchester, TN 37355-3109

Phone

(931) 728-4718

NPI assigned

Aug 15, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Albert R Brandon, D O

Title

Physician

Phone

(931) 728-4718

Specialties & licenses 1

Addresses

Other identifiers 2

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1338854400000",
    "number": "1346432010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "482 INTERSTATE DR STE A",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373553109",
            "telephone_number": "931-728-4718"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "482 INTERSTATE DR STE A",
            "city": "MANCHESTER",
            "state": "TN",
            "postal_code": "373553109",
            "telephone_number": "931-728-4718"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRANDON MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-15",
        "last_updated": "2012-06-05",
        "status": "A",
        "authorized_official_last_name": "BRANDON",
        "authorized_official_first_name": "ALBERT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "931-728-4718",
        "authorized_official_credential": "D O"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "TN",
            "license": "DO212",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBST",
            "identifier": "4107876",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3730155",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cristi Lee Bouldin, DPM
• Eric B Bouldin, D.P.M.
• Macey Elyse Bowman
• Ronald Bradford, D.PH.
• Robin Michael Brady, OD
• Albert R Brandon Jr., DO
• Nicole Lynn Brinkley, FNP
• Ruth Brooks, PTA
• Courtney Johnson Brown, LCSW
• Katherine Rose Brown, LMT, MMP

• Family Medicine Physician in Manchester, TN
• Providers in Manchester, TN by specialty
• Family Medicine Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.