Basic Information
Provider Information
NPI: 1730438920
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRAATZ
FirstName: DAVID
MiddleName: ROBERT
NamePrefix:  
NameSuffix:  
Credential: M.S.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4380 GEORGETOWN SQ
Address2: SUITE 1002
City: ATLANTA
State: GA
PostalCode: 303386254
CountryCode: US
TelephoneNumber: 7702208400
FaxNumber:  
Practice Location
Address1: 3855 PLEASANT HILL RD
Address2: SUITE 280
City: DULUTH
State: GA
PostalCode: 300961407
CountryCode: US
TelephoneNumber: 4042974230
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/03/2012
LastUpdateDate: 08/11/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/11/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
231H00000XAUD003665GAY Speech, Language and Hearing Service ProvidersAudiologist 

No ID Information.


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