Healthcare Provider Details

I. General information

NPI: 1194648352
Provider Name (Legal Business Name): CASSANDRA G. BRACKETT, D.D.S.,P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 MEMORIAL DR STE D3
DECATUR GA
30032-2700
US

IV. Provider business mailing address

3300 MEMORIAL DR STE D3
DECATUR GA
30032-2700
US

V. Phone/Fax

Practice location:
  • Phone: 404-289-3060
  • Fax: 404-288-6080
Mailing address:
  • Phone: 404-289-3060
  • Fax: 402-886-6080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD BRACKETT
Title or Position: OFFICE MANAGER
Credential: BRACKETT
Phone: 404-289-3060