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NPI Code Detail

MEDICARE: DAVID NEIL BRONAUGH P.A.C.

MEDICARE: DAVID NEIL BRONAUGH P.A.C.
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
1363A00000XPhysician Assistant003371GA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447358254
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID NEIL BRONAUGH P.A.C.
Provider Business Mailing Address
First Line : 640 ROLAND MANOR DR
Second Line :
City : DACULA
State : GA
Zip : 30019-6512
Country : US
Telephone Number : 678-376-0525
Fax Number :
Provider Business Practice Location Address
First Line : 3020 HIGHWAY 124
Second Line :
City : SNELLVILLE
State : GA
Zip : 30039-4614
Country : US
Telephone Number : 770-978-1331
Fax Number : 770-978-8580
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2006
Last Update Date : 02/17/2026

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