Healthcare Provider Details

I. General information

NPI: 1538513726
Provider Name (Legal Business Name): ELIRAN BRACHA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/14/2016
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 HOSPITAL PARK
MOULTRIE GA
31768-6772
US

IV. Provider business mailing address

80 COBBLESTONE BLVD SE
MOULTRIE GA
31788-7713
US

V. Phone/Fax

Practice location:
  • Phone: 229-891-9548
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number87659
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberOS21459
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number87659
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number87659
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberW1250
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: