Healthcare Provider Details

I. General information

NPI: 1700602414
Provider Name (Legal Business Name): BRAXTON TURNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1229 FRIENDSHIP RD STE 100
BRASELTON GA
30517-5608
US

IV. Provider business mailing address

2 MOUNT VERNON CIR
SANDY SPRINGS GA
30338-5433
US

V. Phone/Fax

Practice location:
  • Phone: 706-499-2920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13881
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: