Healthcare Provider Details

I. General information

NPI: 1679639355
Provider Name (Legal Business Name): TAMMY C BRANNON MS,PT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

634 TOMMY AARON DR
GAINESVILLE GA
30506-1504
US

IV. Provider business mailing address

634 TOMMY AARON DR
GAINESVILLE GA
30506-1504
US

V. Phone/Fax

Practice location:
  • Phone: 770-503-7337
  • Fax: 770-503-7337
Mailing address:
  • Phone: 770-503-7337
  • Fax: 770-503-7337

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License NumberPT004791
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: