Individual
MRS. NINOSKA MERCEDES BRAVO-MACHADO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5424 CAROLEAN ST, GAINESVILLE, GA 30506-3193
(678) 622-3801
Mailing address
5424 CAROLEAN ST, GAINESVILLE, GA 30506-3193
(678) 622-3801
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
419900792A
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
419900792A
—
GA
Enumeration date
06/12/2012
Last updated
06/12/2012
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