MEDICARE: DR. BRUNO OSCAR DENIS MD

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	207P00000X	Emergency Medicine Physician	026502	GA
2	207Q00000X	Family Medicine Physician	026502	GA

General Provider Information

NPI Number	:	1679519235
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUNO OSCAR DENIS MD

Provider Business Mailing Address
First Line	:	PO BOX 529
Second Line	:
City	:	ROYSTON
State	:	GA
Zip	:	30662-0529
Country	:	US
Telephone Number	:	706-621-7575
Fax Number	:	706-621-7557

Provider Business Practice Location Address
First Line	:	1061 DOWDY RD
Second Line	:	SUITE 101
City	:	ATHENS
State	:	GA
Zip	:	30606-5700
Country	:	US
Telephone Number	:	706-621-7575
Fax Number	:	706-621-7557

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

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	01/15/2021

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