Provider Demographics
NPI:1689664674
Name:BRANCH, MARK ALAN (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:BRANCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 E 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:CORDELE
Mailing Address - State:GA
Mailing Address - Zip Code:31015
Mailing Address - Country:US
Mailing Address - Phone:229-273-1243
Mailing Address - Fax:229-273-1247
Practice Address - Street 1:412 E 4TH AVE
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015
Practice Address - Country:US
Practice Address - Phone:229-273-1243
Practice Address - Fax:229-273-1247
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA81934207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN35067OtherTLC
TN626001636OtherUSA MANAGED CARE
TN3319387Medicaid
TN5093020OtherCIGNA
TN626001636OtherUNITED HEALTHCARE
TN4107725OtherBLUE CROSS BLUE SHIELD
TN626001636OtherHEALTH PARTNERS
TN35067OtherTLC
TN3319387Medicaid