Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 056090 | GA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 056090 | GA |
NPI | 1063415016 |
---|---|
Provider Name | Dr. D Hodari Brooks |
First Address | Atlanta, GA 30339-3035 |
Second Address | Austell, GA 30106-6821 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2005 |
Last Update Date | 13/11/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
056090 | LICENSE (01) | GA |
G69616 | (02) | |
G69616 | (02) | SC |