MEDICARE: DR. CASSANDRA GRIFFITH BRACKETT D.D.S

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	0010117	GA
2	1223X0008X	Oral and Maxillofacial Radiology Dentistry	010117	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033244124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CASSANDRA GRIFFITH BRACKETT D.D.S

Provider Business Mailing Address
First Line	:	3300 MEMORIAL DR
Second Line	:	SUITE D-3
City	:	DECATUR
State	:	GA
Zip	:	30032-2700
Country	:	US
Telephone Number	:	404-289-3060
Fax Number	:	404-288-6080

Provider Business Practice Location Address
First Line	:	3300 MEMORIAL DR
Second Line	:	SUITE D-3
City	:	DECATUR
State	:	GA
Zip	:	30032-2700
Country	:	US
Telephone Number	:	404-289-3060
Fax Number	:	404-288-6080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	03/11/2022

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Directions to “ DR. CASSANDRA GRIFFITH BRACKETT D.D.S” Practice Location

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