Individual
EQUILLA W BRACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
379 COUNTY LINE RD, JENKINSBURG, GA 30234-2313
(770) 775-6949
(770) 504-0783
Mailing address
379 COUNTY LINE RD, JENKINSBURG, GA 30234-2313
(770) 775-6949
(770) 504-0783
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
018-01-008-1
GA
Other
Enumeration date
09/15/2010
Last updated
09/15/2010
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