Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | OPT001375 | GA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT001375 | GA |
NPI | 1154353746 |
---|---|
Provider Name | Dr. Donald Eugene Braxton |
First Address | Atlanta, GA 31131-1619 |
Second Address | Atlanta, GA 30339-6136 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 08/07/2007 |