1376792580 NPI number — MRS. VANESSA CALLAHAN BRAGGER LMT

Table of content: MRS. VANESSA CALLAHAN BRAGGER LMT (NPI 1376792580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376792580 NPI number — MRS. VANESSA CALLAHAN BRAGGER LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAGGER
Provider First Name:
VANESSA
Provider Middle Name:
CALLAHAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376792580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3560 MCEVER RD
Provider Second Line Business Mailing Address:
SUITEB
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30504-5500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
770-535-5522
Provider Business Mailing Address Fax Number:
770-535-5522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3560 MCEVER RD
Provider Second Line Business Practice Location Address:
SUITEB
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30504-5500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-535-5522
Provider Business Practice Location Address Fax Number:
770-535-5522
Provider Enumeration Date:
09/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  MT003779 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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