MEDICARE: DR. D HODARI BROOKS M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	056090	GA
2	207XS0114X	Adult Reconstructive Orthopaedic Surgery Physician	056090	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	056090	OTHER	GA	LICENSE

General Provider Information

NPI Number	:	1063415016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. D HODARI BROOKS M.D

Provider Business Mailing Address
First Line	:	900 CIRCLE 75 PKWY SE
Second Line	:	SUITE 1700
City	:	ATLANTA
State	:	GA
Zip	:	30339-3035
Country	:	US
Telephone Number	:	770-953-6929
Fax Number	:	770-953-6972

Provider Business Practice Location Address
First Line	:	1700 HOSPITAL SOUTH DR STE 502
Second Line	:
City	:	AUSTELL
State	:	GA
Zip	:	30106-8159
Country	:	US
Telephone Number	:	943-202-7070
Fax Number	:	470-986-7020

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	11/14/2022

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