NPIMap

Organization Active NPI

Mary N, Brunner, LLC

  • Optometrist
  • Decatur, GA
National Provider Identifier
1851763916
Registry record updated Oct 28, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
1170-T Issued in GA
Legal business name
MARY N, BRUNNER, LLC
Practice address
4765 Memorial Dr
Decatur, GA 30032-1417
Phone
(404) 296-2307
NPI assigned
Oct 28, 2015
Last updated
Oct 28, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 28, 2015

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

Authorized official

Name
Dr. Mary N Brunner, O.D.
Title
President
Phone
(404) 296-2307

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 1170-T GA Primary

Addresses

Primary practice location

4765 Memorial Dr
Decatur, GA 30032-1417

Mailing address

4765 Memorial Dr
Decatur, GA 30032-1417
Phone (404) 296-2307

National Provider Directory

National Provider Directory

Locations

4765 Memorial Dr
Decatur, GA 30032
Phone (404) 296-2307

Practitioners & affiliated clinicians

Practitioners 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1445990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445990400000",
    "number": "1851763916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4765 MEMORIAL DR",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321417",
            "telephone_number": "404-296-2307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4765 MEMORIAL DR",
            "city": "DECATUR",
            "state": "GA",
            "postal_code": "300321417",
            "telephone_number": "404-296-2307"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY N, BRUNNER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-28",
        "last_updated": "2015-10-28",
        "status": "A",
        "authorized_official_last_name": "BRUNNER",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-296-2307",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "GA",
            "license": "1170-T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Decatur, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2015; 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.