Provider Demographics
NPI:1477031375
Name:ORTA, BRANDEN (CAA)
Entity type:Individual
Prefix:
First Name:BRANDEN
Middle Name:
Last Name:ORTA
Suffix:
Gender:M
Credentials:CAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1325 WILMINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:GRAYSON
Mailing Address - State:GA
Mailing Address - Zip Code:30017-1075
Mailing Address - Country:US
Mailing Address - Phone:678-438-2732
Mailing Address - Fax:
Practice Address - Street 1:6105 PEACHTREE DUNWOODY RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5909
Practice Address - Country:US
Practice Address - Phone:470-308-4905
Practice Address - Fax:470-300-7850
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
367H00000X
GA8946367H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant