Provider Demographics
NPI:1780612408
Name:BRANNON, WILLIAM ANTHONY DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:ANTHONY DAVID
Last Name:BRANNON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 12938
Mailing Address - Street 2:C/O CLINIC MANAGEMENT
Mailing Address - City:CALHOUN
Mailing Address - State:GA
Mailing Address - Zip Code:30703
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1035 RED BUD RD NE
Practice Address - Street 2:
Practice Address - City:CALHOUN
Practice Address - State:GA
Practice Address - Zip Code:30701-6008
Practice Address - Country:US
Practice Address - Phone:706-602-9995
Practice Address - Fax:706-624-0271
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA035011207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000495085BMedicaid
GA000495085EMedicaid
GACM 5659OtherRAILROAD MEDICARE GRP
GA05002007OtherRAILROAD MEDICARE PARTB
GA027237OtherBLUECROSS BLUE SHIELD
GA035011OtherMEDICAL LIC. NUMBER
GA00495085AMedicaid
GA05002007OtherRAILROAD MEDICARE PARTB
GACM 5659OtherRAILROAD MEDICARE GRP