Individual
COLLIER BRANAN GLADIN JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
140 N CREST BLVD, MACON, GA 31210-1845
(478) 757-8335
(478) 757-8353
Mailing address
140 N CREST BLVD, MACON, GA 31210-1845
(478) 757-8335
(478) 757-8353
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
030609
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00383446D
—
GA
01
—
030609
STATE LICENSE
GA
01
—
582393019
FEDERAL TAX ID
GA
Enumeration date
08/19/2006
Last updated
07/08/2007
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