Healthcare Provider Details

I. General information

NPI: 1154353746
Provider Name (Legal Business Name): DONALD EUGENE BRAXTON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2451 CUMBERLAND PKWY SE STE. 3138
ATLANTA GA
30339-6136
US

IV. Provider business mailing address

PO BOX 311619
ATLANTA GA
31131-1619
US

V. Phone/Fax

Practice location:
  • Phone: 770-852-1002
  • Fax: 770-947-9893
Mailing address:
  • Phone: 770-852-1002
  • Fax: 770-947-9893

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT001375
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOPT001375
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: