Individual provider · NPI-1

Michael Lee Brackett, M.D.

Family Medicine · Lagrange, GA

NPI number1083607071
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1083607071
Entity type
Individual (NPI-1)
Name
Michael Lee Brackett
Credential
M.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Aug 25, 2005
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family Medicine026462GAYes

Practice location

122a Gordon Commercial Dr
Lagrange, GA 30240-5740

Phone 706-845-4035

Mailing address

122a Gordon Commercial Dr
Lagrange, GA 30240-5740

Phone 706-845-4035

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