Provider Demographics
NPI:1902565922
Name:BRAGGS, AYANA LYNN
Entity type:Individual
Prefix:MS
First Name:AYANA
Middle Name:LYNN
Last Name:BRAGGS
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 1:200 DAWN REDWOOD DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29307-1448
Mailing Address - Country:US
Mailing Address - Phone:704-322-6892
Mailing Address - Fax:
Practice Address - Street 1:200 DAWN REDWOOD DR STE 200
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29307-1448
Practice Address - Country:US
Practice Address - Phone:704-322-6892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-17
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier