# BENNETT H. BRUCKNER,M.D., P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033370762
- **Authorized official:** DR. BENNETT HOWARD BRUCKNER M.D. (PHYSICIAN/OWNER)
- **Authorized official phone:** (770) 962-9410

## Contact information

- **Practice address:** 575 PROFESSIONAL DR, SUITE 290, LAWRENCEVILLE, GA 30045-3333
- **Practice address phone:** (770) 962-9410
- **Practice address fax:** (770) 962-8489
- **Mailing address:** 575 PROFESSIONAL DR, SUITE 290, LAWRENCEVILLE, GA 30045-3333
- **Mailing address phone:** (770) 962-9410
- **Mailing address fax:** (770) 962-8489

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RG0100X | Gastroenterology Physician | 034547 | GA | Yes |

## Other

- **Enumeration date:** 06/25/2008
- **Last updated:** 06/25/2008