Provider Demographics
NPI:1316104953
Name:FLEISCHMANN, BRANDI MARIE (PA-C)
Entity type:Individual
Prefix:MRS
First Name:BRANDI
Middle Name:MARIE
Last Name:FLEISCHMANN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W HOSPITAL RD
Mailing Address - Street 2:
Mailing Address - City:FORT GORDON
Mailing Address - State:GA
Mailing Address - Zip Code:30905-4470
Mailing Address - Country:US
Mailing Address - Phone:706-787-5811
Mailing Address - Fax:
Practice Address - Street 1:300 W HOSPITAL RD
Practice Address - Street 2:
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-4470
Practice Address - Country:US
Practice Address - Phone:706-787-5811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-21
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1596363A00000X
IN10001620A363A00000X
KYPA1835363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1081766OtherNCCPA ID
IN10001620AOtherINDIANA STATE LICENSE
KYPA1835OtherKENTUCKY STATE LICENSE
TN1596OtherTENNESSEE STATE LICENSE NUMBER
KY12511065OtherCAQH