Healthcare Provider Details

I. General information

NPI: 1174076673
Provider Name (Legal Business Name): LINDALYNN BRAGGS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 08/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7432 OLD GREENSBORO RD
TUSCALOOSA AL
35405-5981
US

IV. Provider business mailing address

7432 OLD GREENSBORO RD
TUSCALOOSA AL
35405-5981
US

V. Phone/Fax

Practice location:
  • Phone: 334-507-1784
  • Fax: 205-632-5808
Mailing address:
  • Phone: 334-507-1784
  • Fax: 205-632-5808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372500000X
TaxonomyChore Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code374700000X
TaxonomyTechnician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3747A0650X
TaxonomyAttendant Care Provider
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: