Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 030963 | GA |
NPI | 1033228796 |
---|---|
Provider Name | Dr. Thomas Paul Branch |
First Address | Decatur, GA 30030-1644 |
Second Address | Decatur, GA 30030-1644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D39465 | (02) | GA |