Healthcare Provider Details

I. General information

NPI: 1447898721
Provider Name (Legal Business Name): SOPHIA BRACEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2019
Last Update Date: 07/14/2024
Certification Date: 07/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3379 PEACHTREE RD NE # 756
ATLANTA GA
30326-1031
US

IV. Provider business mailing address

3379 PEACHTREE RD NE # 756
ATLANTA GA
30326-1031
US

V. Phone/Fax

Practice location:
  • Phone: 708-265-3064
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN311493
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN311493
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN311493
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN311493
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License NumberRN311493
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: