| Bennett H. Bruckner,m.d., P.c. | |
|
575 Professional Dr Suite 290 Lawrenceville GA 30045-3333 | |
| (770) 962-9410 | |
| (770) 962-8489 |
| Full Name | Bennett H. Bruckner,m.d., P.c. |
|---|---|
| Speciality | Internal Medicine - Gastroenterology |
| Location | 575 Professional Dr, Lawrenceville, Georgia |
| Authorized Official Name and Position | Bennett Howard Bruckner (PHYSICIAN/OWNER) |
| Authorized Official Contact | 7709629410 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Bennett H. Bruckner,m.d., P.c. 575 Professional Dr Suite 290 Lawrenceville GA 30045-3333 Ph: (770) 962-9410 | Bennett H. Bruckner,m.d., P.c. 575 Professional Dr Suite 290 Lawrenceville GA 30045-3333 Ph: (770) 962-9410 |
| NPI Number | 1033370762 |
|---|---|
| Provider Enumeration Date | 06/25/2008 |
| Last Update Date | 06/25/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033370762 | NPI | - | NPPES |
| 1639270622 | Other | GA | NPI |
| 00473228A | Medicaid | GA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0100X | Internal Medicine - Gastroenterology | 034547 (Georgia) | Primary |
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