Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | POD000456 | GA |
NPI | 1518948421 |
---|---|
Provider Name | Dr. Madison Tucker Brawner SR. |
First Address | Savannah, GA 31405-4507 |
Second Address | Savannah, GA 31405-4507 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/11/2005 |
Last Update Date | 18/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000178912A | (05) | GA |
U01658 | (02) | GA |