=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659533545
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID A BRCKA MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2008
-----------------------------------------------------
Last Update Date | 04/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2201 NEWNAN CROSSING BLVD E STE 100
-----------------------------------------------------
City | NEWNAN
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30265-2551
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-460-4747
-----------------------------------------------------
Fax | 678-673-5102
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3100 INTERSTATE NORTH CIR SE STE 500
-----------------------------------------------------
City | ATLANTA
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30339-2296
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 770-953-6929
-----------------------------------------------------
Fax | 770-953-6972
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | ME100970
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number | 075264
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------