Provider Demographics
NPI:1902821135
Name:BRANNEN, ALFRED LYNNE II (MD)
Entity Type:Individual
Prefix:
First Name:ALFRED
Middle Name:LYNNE
Last Name:BRANNEN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30901-1055
Mailing Address - Country:US
Mailing Address - Phone:706-922-5864
Mailing Address - Fax:706-922-5819
Practice Address - Street 1:1301 BROAD ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30901-1055
Practice Address - Country:US
Practice Address - Phone:706-922-5864
Practice Address - Fax:706-922-5819
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA030584207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000382764EMedicaid
GAC73077Medicare UPIN
GA29BDCNPMedicare ID - Type Unspecified