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NPI Code Detail

MEDICARE: DR. ILENE BRENNER MD

MEDICARE: DR. ILENE BRENNER 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
1207P00000XEmergency Medicine Physician051120GA

General Provider Information

NPI Number : 1972545929
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ILENE BRENNER MD
Provider Business Mailing Address
First Line : 880 DREWRY ST NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-3811
Country : US
Telephone Number : 404-876-4034
Fax Number :
Provider Business Practice Location Address
First Line : 880 DREWRY ST NE
Second Line :
City : ATLANTA
State : GA
Zip : 30306-3811
Country : US
Telephone Number : 404-876-4034
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2006
Last Update Date : 11/03/2014

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