Judy Bruckner, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2174 Issued in GA

Practice address

1551 Jennings Mill Rd Unit 2000B
Watkinsville, GA 30677-7252

Phone

(706) 316-9095

Fax

(706) 353-8948

NPI assigned

Sep 20, 2006

Last updated

Jan 17, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1996

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Judy a. Bruckner, PH.D., P.C.

  • Psychologist
  • Watkinsville, GA
  • NPI 1528182789
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1673913600000",
    "number": "1104924620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1551 JENNINGS MILL RD UNIT 2000B",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777252",
            "telephone_number": "706-316-9095",
            "fax_number": "706-353-8948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1551 JENNINGS MILL RD UNIT 2000B",
            "city": "WATKINSVILLE",
            "state": "GA",
            "postal_code": "306777252",
            "telephone_number": "706-316-9095",
            "fax_number": "706-353-8948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCKNER",
        "first_name": "JUDY",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-20",
        "last_updated": "2023-01-17",
        "certification_date": "2023-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "GA",
            "license": "2174",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "GA",
            "license": "2174",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD GA",
            "identifier": "582430452",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffanie Brown, DDS
• Traci Lee Brown
• Ivey Broxton, NP
• Bruce L Hammonds OD PC
• Bruckner Counseling
• Christopher K Brune, PA-C
• Laurie Bryan, RBT
• Dennis G Bullock, MD
• Amanda Burgamy, PMHNP-BC
• Sawyer McKinley Burke

• Psychologist in Watkinsville, GA
• Providers in Watkinsville, GA by specialty
• Psychologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.