Organization
BENNETT H. BRUCKNER,M.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENNETT HOWARD BRUCKNER M.D. (PHYSICIAN/OWNER)
(770) 962-9410
Entity
Organization
Contact information
Practice address
575 PROFESSIONAL DR, SUITE 290, LAWRENCEVILLE, GA 30045-3333
(770) 962-9410
(770) 962-8489
Mailing address
575 PROFESSIONAL DR, SUITE 290, LAWRENCEVILLE, GA 30045-3333
(770) 962-9410
(770) 962-8489
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
034547
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00473228A
—
GA
01
—
1639270622
NPI
GA
Enumeration date
06/25/2008
Last updated
06/25/2008
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