Provider Demographics
NPI:1134255904
Name:BRAXLEY, TED MORAN (RN 053898 NP)
Entity type:Individual
Prefix:MR
First Name:TED
Middle Name:MORAN
Last Name:BRAXLEY
Suffix:
Gender:M
Credentials:RN 053898 NP
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Mailing Address - Street 1:811 HEMLOCK ST
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-2144
Mailing Address - Country:US
Mailing Address - Phone:478-751-6120
Mailing Address - Fax:478-751-6099
Practice Address - Street 1:811 HEMLOCK ST
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-2144
Practice Address - Country:US
Practice Address - Phone:478-751-6120
Practice Address - Fax:478-751-6099
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN 53898 NP363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner