Basic Information
| Provider Information | |||||||||
| NPI: | 1053425207 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRUMMER | ||||||||
| FirstName: | CRAIG | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5665 NEW NORTHSIDE DR NW | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303285831 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708745400 | ||||||||
| FaxNumber: | 7708745469 | ||||||||
| Practice Location | |||||||||
| Address1: | 3950 AUSTELL RD | ||||||||
| Address2: | |||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301061121 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7707324000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2006 | ||||||||
| LastUpdateDate: | 03/16/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 056010 | GA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | MD422482 | PA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | A108672 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 036129466 | IL | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 069607741B | 05 | GA | MEDICAID | 06907741C | 05 | GA | MEDICAID | 069607741A | 05 | GA | MEDICAID | 069607741D | 05 | GA | MEDICAID | 1053425207 | 05 | CA | MEDICAID |