MEDICARE: ELIZABETH MARY BRUEHL

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	363A00000X	Physician Assistant	13805	GA

General Provider Information

NPI Number	:	1528883907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARY BRUEHL

Provider Business Mailing Address
First Line	:	2712 N DECATUR RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-5910
Country	:	US
Telephone Number	:	770-491-3003
Fax Number	:	770-491-0729

Provider Business Practice Location Address
First Line	:	2712 N DECATUR RD
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-5910
Country	:	US
Telephone Number	:	770-491-3003
Fax Number	:	770-491-0729

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

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	03/12/2026

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Directions to “ ELIZABETH MARY BRUEHL ” Practice Location

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