Basic Information
| Provider Information | |||||||||
| NPI: | 1154539385 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARDEN | ||||||||
| FirstName: | BRANDON | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2835 BRANDYWINE RD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303415510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042562593 | ||||||||
| FaxNumber: | 7704889408 | ||||||||
| Practice Location | |||||||||
| Address1: | 1000 HAWTHORNE AVE STE S | ||||||||
| Address2: | |||||||||
| City: | ATHENS | ||||||||
| State: | GA | ||||||||
| PostalCode: | 306062168 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042562593 | ||||||||
| FaxNumber: | 7704889408 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2007 | ||||||||
| LastUpdateDate: | 01/22/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | MD.28540 | AL | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 208000000X | MD.28540 | AL | N | Allopathic & Osteopathic Physicians | Pediatrics | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 2080P0202X | 063459 | GA | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 111173 | 05 | AL | MEDICAID | 111256 | 05 | AL | MEDICAID | 1154539385 | 01 | AL | TRICARE SOUTH | OTHER | 515-98963 | 01 | AL | BCBS | OTHER | 515-98918 | 01 | AL | BCBS | OTHER | 003130101A | 05 | GA | MEDICAID |