NPIMap

Individual provider Active NPI

Brett Daniel Puckett, PA-C, MMSC, ATC

  • Physician Assistant
  • Lawrenceville, GA
National Provider Identifier
1265830152
Registry record updated Nov 15, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
10254 Issued in GA
Practice address
771 Old Norcross Rd Ste 390
Lawrenceville, GA 30046-4324
Phone
(678) 957-0757
Fax
(678) 957-9597
NPI assigned
Dec 9, 2014
Last updated
Nov 15, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 15, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 36002274A IN
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 10254 GA Primary

Addresses

Primary practice location

771 Old Norcross Rd Ste 390
Lawrenceville, GA 30046-4324

Mailing address

900 Circle 75 Pkwy SE Ste 1700
Atlanta, GA 30339-3087
Phone (770) 953-6929

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210505000080 GA Practitioner - Physician Assistant 5092124057 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Emory University School of Medicine, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Piedmont Orthopedics, LLCGroup PAC ID 4385963172, 191 clinicians
Physiotherapy Associates IncGroup PAC ID 3577470442, shared by 50 NPIs, 1,432 clinicians

Practice addresses (Care Compare)

1000 Medical Ctr Blvd
Lawrenceville, GA 30046-7694
Phone (678) 957-0757

3605 Braselton Hwy
Suite 101
Dacula, GA 30019-4666
Phone (770) 904-0772

4700 Nelson Brogdon Blvd
Suite 240
Buford, GA 30518-5401
Phone (770) 271-3188

620 Cherokee St NE
Suite 300
Marietta, GA 30060-7202
Phone (770) 635-1812

6300 Hospital Pkwy
Johns Creek, GA 30097-1983

771 Old Norcross Rd
Suite 390
Lawrenceville, GA 30046-4324
Phone (678) 957-0757

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.62 of 100Reported as apm
Quality
83.25
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36002274AINMDAthletic Trainer
10254GAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Orthoatlanta, LLC CurrentSince Jun 6, 2022 Accepting new patients
Orthoatlanta, LLC CurrentSince Jun 6, 2022 Accepting new patients

Locations

900 Circle 75 Pkwy SE
Ste 1700
Atlanta, GA 30339
Phone (770) 953-6929

1265 Highway 54 W
Ste 308
Fayetteville, GA 30214
Phone (678) 216-0771

771 Old Norcross Rd
Ste 390
Lawrenceville, GA 30046
Phone (678) 957-0757

620 Cherokee St NE
Ste 300
Marietta, GA 30060
Phone (770) 635-1812

Organizations & group practices 4

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.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668470400000",
    "number": "1265830152",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 CIRCLE 75 PKWY SE STE 1700",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303393087",
            "telephone_number": "770-953-6929",
            "fax_number": "770-953-6972"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "771 OLD NORCROSS RD STE 390",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300464324",
            "telephone_number": "678-957-0757",
            "fax_number": "678-957-9597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUCKETT",
        "first_name": "BRETT",
        "middle_name": "DANIEL",
        "credential": "PA-C, MMSC, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-12-09",
        "last_updated": "2022-11-15",
        "certification_date": "2021-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IN",
            "license": "36002274A",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "GA",
            "license": "10254",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrenceville, GA

Sources for this page

Verify at the official NPI Registry.