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Organization

BRANNON PEDIATRIC SERVICES, INC.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. TAMMY C BRANNON (DIRECTOR/OWNER)
(770) 503-7337
Entity
Organization

Contact information

Practice address
634 TOMMY AARON DR, GAINESVILLE, GA 30506-1504
(770) 503-7337
Mailing address
634 TOMMY AARON DR, GAINESVILLE, GA 30506-1504
(770) 503-7337

Taxonomy

Speciality
Code
Description
License number
State
2251P0200X
Pediatric Physical Therapist
Primary
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1174645725
GA
05
1225346299
GA
05
1407055692
GA
05
1679639355
GA
05
1770653297
GA
05
1811019326
GA
Enumeration date
10/22/2012
Last updated
03/25/2014
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