Provider Demographics
NPI:1144204918
Name:BRAGG, LEILA SMITH (MSN, APRN, BC, FNP)
Entity Type:Individual
Prefix:MRS
First Name:LEILA
Middle Name:SMITH
Last Name:BRAGG
Suffix:
Gender:F
Credentials:MSN, APRN, BC, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:940 OAKLAWN DR
Mailing Address - Street 2:
Mailing Address - City:SWAINSBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30401-5729
Mailing Address - Country:US
Mailing Address - Phone:478-237-6758
Mailing Address - Fax:
Practice Address - Street 1:328 W MAIN ST
Practice Address - Street 2:
Practice Address - City:SWAINSBORO
Practice Address - State:GA
Practice Address - Zip Code:30401-3104
Practice Address - Country:US
Practice Address - Phone:478-237-7801
Practice Address - Fax:478-237-3883
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN033517363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily