Individual provider Active NPI

Russell L. Branch Jr., CRNA

  • Certified Registered Nurse Anesthetist
  • Marietta, GA
National Provider Identifier
1124096862
Registry record updated Aug 15, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
RN174552 Issued in GA
Practice address
531 Roselane St NW
Suite 830
Marietta, GA 30060
Phone
(770) 794-0477
Fax
(770) 794-3108
NPI assigned
Mar 9, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X RN174552 GA Primary

Addresses

Primary practice location

531 Roselane St NW
Suite 830
Marietta, GA 30060

Mailing address

531 Roselane St NW
Suite 830
Marietta, GA 30060-6913
Phone (770) 794-0477

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse, Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avvsc Lawrenceville, LLC CurrentSince Jul 2, 2023 Accepting new patients
County of Rutherford Office of Budget Director Past Accepting new patients
Georgia Interventional Pain - C, LLC PastSince Jan 14, 2022 Accepting new patients
Atlanta Sports Medicine Surgery Center Past Accepting new patients
Gi Anesthesia of Georgia LLC Nurse Anesthetist, Certified Registered PastSince May 5, 2018 Accepting new patients
Georgia Interventional Pain - D LLC Past Accepting new patients
Georgia Interventional Pain - H, LLC PastSince Apr 6, 2021 Accepting new patients

Locations

600 Professional Dr
Ste 160B
Lawrenceville, GA 30046
Phone (678) 878-4555

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1141862400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534291200000",
    "number": "1124096862",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 ROSELANE ST NW",
            "address_2": "SUITE 830",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300606913",
            "telephone_number": "770-794-0477",
            "fax_number": "770-794-3108"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "531 ROSELANE ST NW",
            "address_2": "SUITE 830",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "30060",
            "telephone_number": "770-794-0477",
            "fax_number": "770-794-3108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRANCH",
        "first_name": "RUSSELL",
        "middle_name": "L.",
        "name_suffix": "Jr.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-09",
        "last_updated": "2018-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "GA",
            "license": "RN174552",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Marietta, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.