Active NPI
Terrence Brandon
- Home Health Agency
- Fairburn, GA
National Provider Identifier
1346705456
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- License
- 060-R-2073
- Practice address
- 415 Tarpan CT
Fairburn, GA 30213-4800 - Phone
- (770) 892-8332
- Fax
- (770) 626-3262
- NPI assigned
- Feb 2, 2019
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | 060-R-2073 | GA | Primary |
Addresses
Primary practice location
415 Tarpan CT
Fairburn, GA 30213-4800
Mailing address
3766 Chapel CV
Douglasville, GA 30135-2885
Phone (770) 892-8332
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 060-R-2073 | Medicaid | GA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 060-R-2073 | GA | MD | Home Health Agency |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brandon Medical Group LLC | Home Health | Current | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1621209600000",
"number": "1346705456",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3766 CHAPEL CV",
"city": "DOUGLASVILLE",
"state": "GA",
"postal_code": "301352885",
"telephone_number": "770-892-8332",
"fax_number": "470-401-1105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 TARPAN CT",
"city": "FAIRBURN",
"state": "GA",
"postal_code": "302134800",
"telephone_number": "770-892-8332",
"fax_number": "770-626-3262"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRANDON",
"first_name": "TERRENCE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-02-02",
"last_updated": "2021-05-17",
"certification_date": "2021-04-24",
"status": "A"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": "GA",
"license": "060-R-2073",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "060-R-2073",
"state": "GA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairburn, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.