Healthcare Provider Details

I. General information

NPI: 1629007216
Provider Name (Legal Business Name): CHARLES L BRAUCHER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 07/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 OGLETHORPE AVE STE 3400
ATHENS GA
30606
US

IV. Provider business mailing address

2727 PACES FERRY RD SE STE 1-1100
ATLANTA GA
30339-6151
US

V. Phone/Fax

Practice location:
  • Phone: 706-613-6080
  • Fax: 706-613-6562
Mailing address:
  • Phone: 470-271-3418
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number030726
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number030726
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: