Individual
BRETT DANIEL PUCKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C, MMSC, ATC
Contact information
Practice address
771 OLD NORCROSS RD STE 390, LAWRENCEVILLE, GA 30046-4324
(678) 957-0757
(678) 957-9597
Mailing address
900 CIRCLE 75 PKWY SE STE 1700, ATLANTA, GA 30339-3087
(770) 953-6929
(770) 953-6972
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
36002274A
IN
363A00000X
Physician Assistant
Primary
10254
GA
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
12/09/2014
Last updated
11/15/2022
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