Individual
BONNIE G BRACKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
303 PARKWAY DR NE, PMB 404, ATLANTA, GA 30312-1212
(404) 265-4520
(404) 265-3894
Mailing address
PO BOX 932925, ATLANTA, GA 31193-2925
(800) 364-9216
(423) 892-5838
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN053969
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000561602D
—
GA
01
—
1578518478
NPI
GA
01
—
1982637419
GROUP NPI
GA
01
—
N358317
WELLCARE MEDICAID
GA
01
—
P00385232
RAILROAD MEDICARE
—
Enumeration date
05/23/2006
Last updated
10/09/2008
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