Provider Demographics
NPI:1962071563
Name:BRACKEN, SARALYN WILSON (CRT, RRT)
Entity type:Individual
Prefix:
First Name:SARALYN
Middle Name:WILSON
Last Name:BRACKEN
Suffix:
Gender:F
Credentials:CRT, RRT
Other - Prefix:
Other - First Name:SARALYN
Other - Middle Name:ELIZABETH
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRT, RRT
Mailing Address - Street 1:415 MORGAN FALLS RD APT 1102
Mailing Address - Street 2:
Mailing Address - City:SANDY SPRINGS
Mailing Address - State:GA
Mailing Address - Zip Code:30350-5852
Mailing Address - Country:US
Mailing Address - Phone:678-223-1279
Mailing Address - Fax:
Practice Address - Street 1:1001 JOHNSON FY RD NE
Practice Address - Street 2:
Practice Address - City:SANDY SPRINGS
Practice Address - State:GA
Practice Address - Zip Code:30342-1605
Practice Address - Country:US
Practice Address - Phone:404-785-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA175992227900000X
GA11179227900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, Registered