Healthcare Provider Details

I. General information

NPI: 1174452023
Provider Name (Legal Business Name): DAINELLE L BRANTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3725 WEEMS RD STE 1
COLUMBUS GA
31909-3702
US

IV. Provider business mailing address

3725 WEEMS RD STE 1
COLUMBUS GA
31909-3702
US

V. Phone/Fax

Practice location:
  • Phone: 706-286-8888
  • Fax:
Mailing address:
  • Phone: 706-286-8888
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: