Equilla W Brackett
Individual provider Active NPI Assisted Living Facility · Jenkinsburg, GA
NPI 1982912721 · NPPES record last updated Sep 15, 2010
Key facts
- NPI
- 1982912721
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Assisted Living Facility 310400000X
- License
- 018-01-008-1 (GA)
- Practice address
- 379 County Line Rd
Jenkinsburg, GA 30234-2313 - Phone
- (770) 775-6949
- Fax
- (770) 504-0783
- NPI assigned
- Sep 15, 2010
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 018-01-008-1 | GA | Yes |
Addresses
Primary practice location
379 County Line Rd
Jenkinsburg, GA 30234-2313
Mailing address
379 County Line Rd
Jenkinsburg, GA 30234-2313
Phone (770) 775-6949
Other providers in Jenkinsburg, GA
- A Silverlining Counseling, Inc.
- Sheena Bryant
- First Priority Homecare Services
- McIntosh Trail CSB
- Derek McKibben
- Mercy EMS, LLC
All providers in Jenkinsburg, GA · Assisted Living Facility in Georgia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 15, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.