MEDICARE: CASSANDRA G. BRACKETT, D.D.S.,P.C.

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	261QD0000X	Dental Clinic/Center	0010117	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	:	1942535091
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASSANDRA G. BRACKETT, D.D.S.,P.C.

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	:	CEO
Name	:	DR. CASSANDRA G. BRACKETT
Credential	:	D.D.S.
Telephone Number	:	404-289-3060

Provider Enumeration Date	:	10/07/2009
Last Update Date	:	10/07/2009

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