Individual
LARRY A BRANNAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 JOHNSON FERRY RD NE, ATLANTA, GA 30342-1606
(404) 851-6936
Mailing address
PO BOX 2968, KENNESAW, GA 30156-9117
(770) 779-0015
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
041268
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000697738
—
GA
05
—
000697738C
—
GA
05
—
000697738D
—
GA
01
—
10038074
AMERIGROUP
GA
01
—
10735
KAISER
GA
01
—
198017
BCBS OF GEORGIA
GA
01
—
333395
WELLCARE OF GEORGIA
GA
01
—
573274
BCBS OF GEORGIA
GA
Enumeration date
02/15/2006
Last updated
11/08/2008
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