Provider Demographics
NPI:1497866248
Name:BRANER, HENRY J (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:HENRY
Middle Name:J
Last Name:BRANER
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
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Mailing Address - Street 1:603 PEAR ORCHARD LN
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-6767
Mailing Address - Country:US
Mailing Address - Phone:912-489-3938
Mailing Address - Fax:
Practice Address - Street 1:16TH STREET BUILDING 13514
Practice Address - Street 2:YOUTH CHALLANGE ACADEMY
Practice Address - City:FT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31315
Practice Address - Country:US
Practice Address - Phone:912-242-6542
Practice Address - Fax:912-767-6445
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2016-03-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA001989363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA100000781AMedicaid