Individual provider Active NPI

Cynthia Moore Brandon, APRN, FNP-BC

  • Nurse Practitioner
  • Canton, GA
National Provider Identifier
1649748096
Registry record updated May 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
226133 Issued in GA
Practice address
1495 Hickory Flat Hwy Ste 100
Canton, GA 30115-4266
Phone
(678) 341-6360
Fax
(678) 626-7900
NPI assigned
Nov 4, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 226133 GA Primary

Addresses

Primary practice location

1495 Hickory Flat Hwy Ste 100
Canton, GA 30115-4266

Mailing address

165 Blue Ridge Overlook
Blue Ridge, GA 30513-4431
Phone (706) 946-5607

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190808003782 GA Practitioner - Nurse Practitioner 8022345321 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
226133GAMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Georgia Mountains Health Services, Inc. CurrentSince Feb 13, 2023 Accepting new patients
Georgia Mountains Health Services, Inc. CurrentSince Feb 13, 2023 Accepting new patients
Favor Family Medical Practice LLC CurrentSince Jan 10, 2025 Accepting new patients
Georgia Mountains Health Services, Inc. Current Accepting new patients
Southeast Medical Group, P.C. CurrentSince Apr 22, 2024 Accepting new patients
Creative Hospice Care Inc Past Accepting new patients
Physician First Health Network PastSince Jun 3, 2025 Accepting new patients

Locations

165 Blue Ridge Overlook
Blue Ridge, GA 30513
Phone (706) 946-4647

1255 Friendship Rd
Ste 130
Braselton, GA 30517
Phone (678) 341-6350

1495 Hickory Flat Hwy
Ste 100
Canton, GA 30115
Phone (678) 341-6360

500 Green Rd
Chatsworth, GA 30705
Phone (706) 517-2200

1008 N 3rd Ave
Chatsworth, GA 30705
Phone (706) 517-2273

103 Mountain Brook Dr
Ste 100
Holly Springs, GA 30115
Phone (470) 227-8130

Interoperability endpoints

  • Direct secure messaging: cynthia.brandon.1@31114.direct.athenahealth.com
  • FHIR API: https://fhir4.healow.com/fhir/r4/DIJIBA

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1541289600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715212800000",
    "number": "1649748096",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "165 BLUE RIDGE OVERLOOK",
            "city": "BLUE RIDGE",
            "state": "GA",
            "postal_code": "305134431",
            "telephone_number": "706-946-5607",
            "fax_number": "706-374-7628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1495 HICKORY FLAT HWY STE 100",
            "city": "CANTON",
            "state": "GA",
            "postal_code": "301154266",
            "telephone_number": "678-341-6360",
            "fax_number": "678-626-7900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANDON",
        "first_name": "CYNTHIA",
        "middle_name": "MOORE",
        "credential": "APRN, FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-04",
        "last_updated": "2024-05-09",
        "certification_date": "2024-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "GA",
            "license": "226133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Canton, GA

Sources for this page

Verify at the official NPI Registry.