Healthcare Provider Details

I. General information

NPI: 1346244985
Provider Name (Legal Business Name): JAMES PALMER BRANCH D.P.M
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4705 LAWRENCEVILLE HWY NW SUITE C
LILBURN GA
30047-3667
US

IV. Provider business mailing address

4705 LAWRENCEVILLE HWY NW SUITE C
LILBURN GA
30047-3667
US

V. Phone/Fax

Practice location:
  • Phone: 770-921-8800
  • Fax:
Mailing address:
  • Phone: 770-921-8800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD000918
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: