Provider Demographics
NPI:1093690802
Name:GAJIC, BRANKA
Entity type:Individual
Prefix:
First Name:BRANKA
Middle Name:
Last Name:GAJIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 LANTERN WOOD DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTDALE
Mailing Address - State:GA
Mailing Address - Zip Code:30079-1889
Mailing Address - Country:US
Mailing Address - Phone:678-437-8518
Mailing Address - Fax:
Practice Address - Street 1:534 LANTERN WOOD DR
Practice Address - Street 2:
Practice Address - City:SCOTTDALE
Practice Address - State:GA
Practice Address - Zip Code:30079-1889
Practice Address - Country:US
Practice Address - Phone:678-437-8518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-11
Last Update Date:2025-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSW0093121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical