Individual
SHANNON BRAGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1551 PINE CREEK WAY, WOODSTOCK, GA 30188-4355
(770) 871-6338
Mailing address
112 MIRRAMONT LAKE DR, WOODSTOCK, GA 30189-8213
(404) 509-7986
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP007063
GA
Other
Enumeration date
03/02/2015
Last updated
09/23/2022
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