| Doctor Name: | BRAE ACREE FANNON |
| NPI Number: | 1295877934 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN |
| License Number: | RN123234 |
| Business Practice Address: | 7950 Martin Loop Fort Benning, GA - 319055647 |
| Business Phone Number: | 7065441477 |
| Business Fax Number: | |
| Mailing Address: | 144 Bentwood Dr, ELLERSLIE |
| State: | GA |
| Postal Code: | 318075502 |
| Phone Number: | 7066107397 |
| Fax Number: | |
| NPI Enumeration Date: | 02/12/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 163WP0200X |
| License Number: | RN123234 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | GA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Registered Nurse |
| Taxonomy Specialization: | Pediatrics |
| Taxonomy Definition: | |