Healthcare Provider Details

I. General information

NPI: 1073670709
Provider Name (Legal Business Name): ROBIN ANN BRACKETT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3820 MEDICAL PARK DR. GEORGIA LUNG ASSOCIATES PC.
AUSTELL GA
30106-1110
US

IV. Provider business mailing address

3820 MEDICAL PARK DR. GEORGIA LUNG ASSOCIATES PC.
AUSTELL GA
30106-1110
US

V. Phone/Fax

Practice location:
  • Phone: 770-948-6041
  • Fax: 770-948-7994
Mailing address:
  • Phone: 770-948-6041
  • Fax: 770-948-7994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number178191
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN101397
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: