Healthcare Provider Details

I. General information

NPI: 1962071563
Provider Name (Legal Business Name): SARALYN WILSON BRACKEN CRT, RRT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SARALYN ELIZABETH WILSON CRT, RRT

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 06/18/2021
Certification Date: 06/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 JOHNSON FY RD NE
SANDY SPRINGS GA
30342-1605
US

IV. Provider business mailing address

415 MORGAN FALLS RD APT 1102
SANDY SPRINGS GA
30350-5852
US

V. Phone/Fax

Practice location:
  • Phone: 404-785-5437
  • Fax:
Mailing address:
  • Phone: 678-223-1279
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number175992
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number11179
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: