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NPI Code Detail

MEDICARE: BRIAN S BORTNICK, M.D., PC

MEDICARE: BRIAN S BORTNICK, M.D., PC
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
12084P0800XPsychiatry Physician039294GA

General Provider Information

NPI Number : 1558456863
Entity Type Code : Organization
Provider Name (Legal Business Name) : BRIAN S BORTNICK, M.D., PC
Provider Business Mailing Address
First Line : 810 BROOKRIDGE DR NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-3619
Country : US
Telephone Number : 404-847-9560
Fax Number : 404-847-9537
Provider Business Practice Location Address
First Line : 18 LENOX POINTE NE STE A
Second Line :
City : ATLANTA
State : GA
Zip : 30324-7402
Country : US
Telephone Number : 404-847-9560
Fax Number : 404-847-9537
Authorized Official
Title or Position : BOARD CERTIFIED PSYCHIATRIST
Name : DR. BRIAN S BORTNICK
Credential : M.D.
Telephone Number : 404-847-9560
Provider Enumeration Date : 10/03/2006
Last Update Date : 08/10/2010

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