Provider Demographics
NPI:1871566885
Name:BRANCEWICZ, KAREN M (PAC)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:M
Last Name:BRANCEWICZ
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 10231
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30368
Mailing Address - Country:US
Mailing Address - Phone:770-460-4075
Mailing Address - Fax:770-460-4319
Practice Address - Street 1:101 YORKTOWN
Practice Address - Street 2:STE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:770-460-4075
Practice Address - Fax:770-460-4319
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2011-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA000841L207R00000X
GA006063207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS549361Medicare UPIN
PA075010R7RMedicare PIN
PAP00104194Medicare PIN
PA075010R7RMedicare Oscar/Certification
PACG1496Medicare PIN