Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 016879 | GA |
NPI | 1003854084 |
---|---|
Provider Name | Joseph J Braintwain |
First Address | Atlanta, GA 30305-1578 |
Second Address | Marietta, GA 30068-5425 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2006 |
Last Update Date | 21/08/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00133977C | (05) | GA |
D44908 | (02) | GA |