Provider Demographics
NPI:1336872787
Name:BRACEY, ELOISE MARIE
Entity type:Individual
Prefix:
First Name:ELOISE
Middle Name:MARIE
Last Name:BRACEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:794 BRYSON LAKE CIR
Mailing Address - Street 2:
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30134-5915
Mailing Address - Country:US
Mailing Address - Phone:678-523-1578
Mailing Address - Fax:
Practice Address - Street 1:794 BRYSON LAKE CIR
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5915
Practice Address - Country:US
Practice Address - Phone:678-523-1578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-04
Last Update Date:2022-07-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator