Provider Demographics
NPI:1770548877
Name:BRAVERMAN, JUANA M (MD MPH)
Entity type:Individual
Prefix:
First Name:JUANA
Middle Name:M
Last Name:BRAVERMAN
Suffix:
Gender:F
Credentials:MD MPH
Other - Prefix:
Other - First Name:JUANA
Other - Middle Name:MARIA
Other - Last Name:SANCHEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2625 BEAVER RUIN RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:30071-4136
Mailing Address - Country:US
Mailing Address - Phone:770-446-2820
Mailing Address - Fax:770-446-2868
Practice Address - Street 1:2625 BEAVER RUIN RD
Practice Address - Street 2:SUITE B
Practice Address - City:NORCROSS
Practice Address - State:GA
Practice Address - Zip Code:30071-4136
Practice Address - Country:US
Practice Address - Phone:770-446-2820
Practice Address - Fax:770-446-2868
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA031536208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
G11642Medicare UPIN