Provider Demographics
NPI:1134516693
Name:BRANNAN, CATHARINE MOSS (DMD)
Entity Type:Individual
Prefix:DR
First Name:CATHARINE
Middle Name:MOSS
Last Name:BRANNAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CATHARINE
Other - Middle Name:ELIZABETH
Other - Last Name:MOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:160 COVINGTON DR
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-4449
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1600 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31707-3461
Practice Address - Country:US
Practice Address - Phone:229-432-2103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-22
Last Update Date:2019-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0151361223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics