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General NPI Number Information
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NPI Number | 1134516693
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Entity Type | Individual
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Provider Name | CATHARINE MOSS BRANNAN DMD
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Gender | Female
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 11/08/2019
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Provider Practice Location Address
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Address Line | 1600 W 3RD AVE
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City | ALBANY
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State | GA
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Zip | 31707-3461
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Country | US
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Telephone | 229-432-2103
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Fax |
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Provider Business Mailing Address
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Address Line | 160 COVINGTON DR
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City | MACON
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State | GA
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Zip | 31210-4449
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN015136
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License Number State | GA
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