Active NPI
Geoffrey Broocker, M.D.
- Ophthalmology Physician
- Atlanta, GA
National Provider Identifier
1396856902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 30965
- Practice address
- 1365 Clifton Rd NE # B
Atlanta, GA 30322-1013 - Phone
- (404) 778-3431
- Fax
- (404) 778-4143
- NPI assigned
- Aug 31, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 30965 | GA | Primary |
Addresses
Primary practice location
1365 Clifton Rd NE # B
Atlanta, GA 30322-1013
Mailing address
1365 Clifton Rd NE # B
Atlanta, GA 30322-1013
Phone (404) 778-3431
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1396856902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1365 CLIFTON RD NE # B",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303221013",
"telephone_number": "404-778-3431",
"fax_number": "404-778-4143"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1365 CLIFTON RD NE # B",
"city": "ATLANTA",
"state": "GA",
"postal_code": "303221013",
"telephone_number": "404-778-3431",
"fax_number": "404-778-4143"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BROOCKER",
"first_name": "GEOFFREY",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "GA",
"license": "30965",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atlanta, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.