Provider Demographics
NPI:1831966639
Name:BRAGGS, ANIYAH KEISHONA (PTA)
Entity type:Individual
Prefix:
First Name:ANIYAH
Middle Name:KEISHONA
Last Name:BRAGGS
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 STONE RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:HIRAM
Mailing Address - State:GA
Mailing Address - Zip Code:30141-4591
Mailing Address - Country:US
Mailing Address - Phone:662-400-0671
Mailing Address - Fax:
Practice Address - Street 1:1332 S ZACK HINTON PKWY
Practice Address - Street 2:
Practice Address - City:MCDONOUGH
Practice Address - State:GA
Practice Address - Zip Code:30253-3354
Practice Address - Country:US
Practice Address - Phone:770-898-5401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-11
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPTA005131225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant