Provider Demographics
NPI:1811294044
Name:BRAMLETT REHABILITATION SERVICES, INC
Entity type:Organization
Organization Name:BRAMLETT REHABILITATION SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROBIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRAMLETT
Authorized Official - Suffix:
Authorized Official - Credentials:MED
Authorized Official - Phone:770-630-4852
Mailing Address - Street 1:1509 AMBERSTAPP STUDDARD RD
Mailing Address - Street 2:
Mailing Address - City:SOCIAL CIRCLE
Mailing Address - State:GA
Mailing Address - Zip Code:30025-4401
Mailing Address - Country:US
Mailing Address - Phone:770-630-4852
Mailing Address - Fax:770-464-1462
Practice Address - Street 1:1509 AMBERSTAPP STUDDARD RD
Practice Address - Street 2:
Practice Address - City:SOCIAL CIRCLE
Practice Address - State:GA
Practice Address - Zip Code:30025-4401
Practice Address - Country:US
Practice Address - Phone:770-630-4852
Practice Address - Fax:770-464-1462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOT003268225X00000X
GASLP005098235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000936977BMedicaid
GA000938176AMedicaid