Nicolle Braggs

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

95 Partridge Dr Ste 105
Covington, GA 30016-1185

Phone

(678) 905-1500

Fax

(678) 905-1500

NPI assigned

Mar 23, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• The Itd Group LLC

  • Developmental Therapist
  • Conyers, GA
  • NPI 1639561905

  Case Manager/Care Coordinator

  NPD

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

{
    "created_epoch": "1616457600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616457600000",
    "number": "1679159263",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "95 PARTRIDGE DR STE 105",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300161185",
            "telephone_number": "678-905-1500",
            "fax_number": "678-905-1500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "95 PARTRIDGE DR STE 105",
            "city": "COVINGTON",
            "state": "GA",
            "postal_code": "300161185",
            "telephone_number": "678-905-1500",
            "fax_number": "678-905-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRAGGS",
        "first_name": "NICOLLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-03-23",
        "last_updated": "2021-03-23",
        "certification_date": "2021-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Natalie Paige Boutelle
• Gary Bowen
• S Dawn Bowles
• Endia Boyd, NP
• Boyha LLC
• Jennifer Carol Bridges, RN
• Mineka Bridges, RPH
• Lawrence Monroe Briggs II, PHARMD
• Bright Start
• Brinsonnia Compassionate Care LLC

• All providers in Covington, GA
• Case Manager/Care Coordinator in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2021; 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.