Provider Demographics
NPI:1720871486
Name:BRANNON, OBIE
Entity type:Individual
Prefix:
First Name:OBIE
Middle Name:
Last Name:BRANNON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 BALD RIDGE MARINA RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30041-8526
Mailing Address - Country:US
Mailing Address - Phone:678-756-3726
Mailing Address - Fax:
Practice Address - Street 1:1200 BALD RIDGE MARINA RD STE 200
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30041-8526
Practice Address - Country:US
Practice Address - Phone:770-781-8650
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program