Provider Demographics
NPI:1346244985
Name:BRANCH, JAMES PALMER (DPM)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:PALMER
Last Name:BRANCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4705 LAWRENCEVILLE HWY NW
Mailing Address - Street 2:SUITE C
Mailing Address - City:LILBURN
Mailing Address - State:GA
Mailing Address - Zip Code:30047-3667
Mailing Address - Country:US
Mailing Address - Phone:770-921-8800
Mailing Address - Fax:
Practice Address - Street 1:4705 LAWRENCEVILLE HWY NW
Practice Address - Street 2:SUITE C
Practice Address - City:LILBURN
Practice Address - State:GA
Practice Address - Zip Code:30047-3667
Practice Address - Country:US
Practice Address - Phone:770-921-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000918213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000930069KMedicaid
GA000930069KMedicaid
GA6074200001Medicare NSC