Provider Demographics
NPI:1679792931
Name:BRAGG, GEORGETTE BACKUS (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:GEORGETTE
Middle Name:BACKUS
Last Name:BRAGG
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 EGRET PT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-8111
Mailing Address - Country:US
Mailing Address - Phone:912-232-4110
Mailing Address - Fax:
Practice Address - Street 1:101 EGRET PT
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-8111
Practice Address - Country:US
Practice Address - Phone:912-232-4110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2012-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA34544261QA1903X
GARN055680367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical