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General NPI Number Information
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NPI Number | 1497866248
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Entity Type | Individual
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Provider Name | HENRY J BRANER PHYSICIAN ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 03/28/2016
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Provider Practice Location Address
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Address Line | 16TH STREET BUILDING 13514 YOUTH CHALLANGE ACADEMY
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City | FT STEWART
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State | GA
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Zip | 31315
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Country | US
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Telephone | 912-242-6542
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Fax | 912-767-6445
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Provider Business Mailing Address
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Address Line | 603 PEAR ORCHARD LN
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City | STATESBORO
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State | GA
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Zip | 30458-6767
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Country | US
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Telephone | 912-489-3938
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 001989
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License Number State | GA
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