Bennett H. Bruckner,M.D., P.C.

Primary specialty

Gastroenterology PhysicianTaxonomy code 207RG0100X

License

034547 Issued in GA

Legal business name

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

Practice address

575 Professional Dr
Suite 290
Lawrenceville, GA 30045-3333

Phone

(770) 962-9410

Fax

(770) 962-8489

NPI assigned

Jun 25, 2008

Last updated

Jun 25, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Bennett Howard Bruckner, M.D.NPI 1639270622

Title

Physician/Owner

Phone

(770) 962-9410

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Bennett Howard Bruckner, M.D.

  • Gastroenterology Physician
  • Spartanburg, SC
  • NPI 1639270622
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214352000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1214352000000",
    "number": "1033370762",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 PROFESSIONAL DR",
            "address_2": "SUITE 290",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300453333",
            "telephone_number": "770-962-9410",
            "fax_number": "770-962-8489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "575 PROFESSIONAL DR",
            "address_2": "SUITE 290",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300453333",
            "telephone_number": "770-962-9410",
            "fax_number": "770-962-8489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BENNETT H. BRUCKNER,M.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-25",
        "last_updated": "2008-06-25",
        "status": "A",
        "authorized_official_last_name": "BRUCKNER",
        "authorized_official_first_name": "BENNETT",
        "authorized_official_middle_name": "HOWARD",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "770-962-9410",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "GA",
            "license": "034547",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1639270622",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00473228A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kimberly Benefield
• Richard Wayne Benefield, PA-C
• Mary T Benjamin, DDS
• Sarahlee Benjamin
• Katherine Stroer Benkeser, PT, DPT
• Amanda Bennett, CPNP
• Ashley Bennett, MA, RDN, LD
• Corey Bennett
• Kristin Leigh Bennett, NP-C
• Rhonda Kay Bennett, RN

• Gastroenterology Physician in Lawrenceville, GA
• Providers in Lawrenceville, GA by specialty
• Gastroenterology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.