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EQUILLA W BRACKETT

>> Assisted Living Facility >> Nursing & Custodial Care Facilities

Registrant NPI Number: 1982912721

Individual Registrant:
 EQUILLA W BRACKETT 
Gender: F
Sole Proprietor

Location and contact information for practice:
379 COUNTY LINE RD  JENKINSBURG, GA 30234-2313 US
Tel: 770-775-6949  Fax: 770-504-0783

Contact information for business:
379 COUNTY LINE RD  JENKINSBURG, GA 30234-2313 US
Tel: 770-775-6949  Fax: 770-504-0783

Registration Information:
NPI: 1982912721
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y310400000XNursing & Custodial Care Facilities
Assisted Living Facility
GA018-01-008-1

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




HEALTH CARE JOBS GA - Page 1



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