Individual
ALEXCIUS BRANCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3522 HABERSHAM AT NORTHLAKE STE B, TUCKER, GA 30084-4009
(901) 606-7966
Mailing address
3522 HABERSHAM AT NORTHLAKE STE B, TUCKER, GA 30084-4009
Taxonomy
Speciality
Code
Description
License number
State
101YP1600X
Pastoral Counselor
Primary
—
GA
172V00000X
Community Health Worker
—
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
812990
COMMUNITY HEALTH/MULTI-SERVICE
GA
Enumeration date
03/19/2021
Last updated
03/19/2021
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