Provider Demographics
NPI:1184739435
Name:BRANCH, CLINTON EMMITT JR (MD, FAAN)
Entity type:Individual
Prefix:DR
First Name:CLINTON
Middle Name:EMMITT
Last Name:BRANCH
Suffix:JR
Gender:M
Credentials:MD, FAAN
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Mailing Address - Street 1:1240 JESSE JEWELL PKWY SE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3862
Mailing Address - Country:US
Mailing Address - Phone:770-534-1117
Mailing Address - Fax:770-503-7285
Practice Address - Street 1:1240 JESSE JEWELL PKWY SE
Practice Address - Street 2:SUITE 400
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3862
Practice Address - Country:US
Practice Address - Phone:770-534-1117
Practice Address - Fax:770-503-7285
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
GA0168782084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000178637FMedicaid
GA13DDMFOtherMEDICARE ID
GA016878OtherLICENSE
GA016878OtherLICENSE
GA000178637FMedicaid