| Judy A. Bruckner, Ph.d., P.c. | |
|
1551 Jennings Mill Rd Unit 2000b Watkinsville GA 30677-7252 | |
| (706) 316-9095 | |
| (706) 353-8948 |
| Full Name | Judy A. Bruckner, Ph.d., P.c. |
|---|---|
| Speciality | Psychologist |
| Location | 1551 Jennings Mill Rd Unit 2000b, Watkinsville, Georgia |
| Authorized Official Name and Position | Judy Bruckner (PRESIDENT) |
| Authorized Official Contact | 7063169095 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Judy A. Bruckner, Ph.d., P.c. 1551 Jennings Mill Rd Unit 2000b Watkinsville GA 30677-7252 Ph: (706) 316-9095 | Judy A. Bruckner, Ph.d., P.c. 1551 Jennings Mill Rd Unit 2000b Watkinsville GA 30677-7252 Ph: (706) 316-9095 |
| NPI Number | 1528182789 |
|---|---|
| Provider Enumeration Date | 03/16/2007 |
| Last Update Date | 01/24/2023 |
| Certification Date | 01/24/2023 |
| Medicare PECOS PAC ID | 5092945568 |
|---|---|
| Medicare Enrollment ID | O20140228000854 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528182789 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY002174 (Georgia) | Primary |
| Provider Name | Judy A Bruckner |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1104924620 PECOS PAC ID: 8820068612 Enrollment ID: I20040729000036 |
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