MEDICARE: SARALYN WILSON BRACKEN CRT, RRT

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	227900000X	Registered Respiratory Therapist	175992	GA
2	227900000X	Registered Respiratory Therapist	11179	GA

General Provider Information

NPI Number	:	1962071563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARALYN WILSON BRACKEN CRT, RRT

Provider Business Mailing Address
First Line	:	415 MORGAN FALLS RD APT 1102
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30350-5852
Country	:	US
Telephone Number	:	678-223-1279
Fax Number	:

Provider Business Practice Location Address
First Line	:	1001 JOHNSON FY RD NE
Second Line	:
City	:	SANDY SPRINGS
State	:	GA
Zip	:	30342-1605
Country	:	US
Telephone Number	:	404-785-5437
Fax Number	:

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

Provider Enumeration Date	:	06/18/2021
Last Update Date	:	06/18/2021

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