Healthcare Provider Details

I. General information

NPI: 1649273798
Provider Name (Legal Business Name): PHILIP SIGMUND BRACHMAN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1745 PEACHTREE ROAD, SUITE U KAISER PERMANENTE BROOKWOOD MEDICAL CENTER
ATLANTA GA
30309
US

IV. Provider business mailing address

3495 PIEDMONT ROAD, NE NINE PIEDMONT CENTER
ATLANTA GA
30305
US

V. Phone/Fax

Practice location:
  • Phone: 404-888-7688
  • Fax: 404-355-1353
Mailing address:
  • Phone: 404-364-7070
  • Fax: 404-355-1353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number30962
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number030962
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: