Healthcare Provider Details

I. General information

NPI: 1972090884
Provider Name (Legal Business Name): CAITLYN DIANA BRASCHI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2018
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

69 JESSE HILL JR DR SE
ATLANTA GA
30303-3033
US

IV. Provider business mailing address

69 JESSE HILL JR DR SE
ATLANTA GA
30303-3033
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-3712
  • Fax: 404-778-5033
Mailing address:
  • Phone: 404-778-3712
  • Fax: 404-778-5033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number111483
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA165051
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number111483
License Number StateGA
# 4
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number111483
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: