Provider Demographics
NPI:1033244124
Name:BRACKETT, CASSANDRA GRIFFITH (DDS)
Entity Type:Individual
Prefix:DR
First Name:CASSANDRA
Middle Name:GRIFFITH
Last Name:BRACKETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 MEMORIAL DR
Mailing Address - Street 2:SUITE D-3
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30032-2700
Mailing Address - Country:US
Mailing Address - Phone:404-289-3060
Mailing Address - Fax:404-288-6080
Practice Address - Street 1:3300 MEMORIAL DR
Practice Address - Street 2:SUITE D-3
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30032-2700
Practice Address - Country:US
Practice Address - Phone:404-289-3060
Practice Address - Fax:404-288-6080
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA00101171223G0001X
GA0101171223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000310318CMedicaid