Provider Demographics
NPI:1851394969
Name:BRANCH, CARLA S (MD)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:S
Last Name:BRANCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:658 NORTHSIDE DR E
Mailing Address - Street 2:STE A
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-4828
Mailing Address - Country:US
Mailing Address - Phone:912-764-9684
Mailing Address - Fax:912-489-8676
Practice Address - Street 1:658 NORTHSIDE DR E
Practice Address - Street 2:STE A
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-4828
Practice Address - Country:US
Practice Address - Phone:912-764-9684
Practice Address - Fax:912-489-8676
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-09-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA029847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00447092EMedicaid
GA08BBTGXMedicare ID - Type Unspecified
GA080157471Medicare ID - Type UnspecifiedRRMC
GA00447092EMedicaid