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General NPI Number Information
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NPI Number | 1720871486
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Entity Type | Individual
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Provider Name | OBIE BRANNON
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Gender | Male
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Dates
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Enumeration Date | 05/27/2025
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1200 BALD RIDGE MARINA RD STE 200
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City | CUMMING
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State | GA
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Zip | 30041-8526
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Country | US
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Telephone | 770-781-8650
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Fax |
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Provider Business Mailing Address
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Address Line | 1200 BALD RIDGE MARINA RD STE 200
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City | CUMMING
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State | GA
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Zip | 30041-8526
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Country | US
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Telephone | 678-756-3726
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DN123842
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License Number State | GA
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