Provider Demographics
NPI:1760550107
Name:BRANCH, WALTER DEWEY II (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:DEWEY
Last Name:BRANCH
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 RIDGE PINE DR
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-4466
Mailing Address - Country:US
Mailing Address - Phone:706-364-6886
Mailing Address - Fax:
Practice Address - Street 1:300 W HOSPITAL ROAD
Practice Address - Street 2:ATTN CREDENTIALS
Practice Address - City:FORT GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905-5650
Practice Address - Country:US
Practice Address - Phone:706-787-2720
Practice Address - Fax:708-787-8176
Is Sole Proprietor?:No
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA03880207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine