Basic Information
| Provider Information | |||||||||
| NPI: | 1063415016 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BROOKS | ||||||||
| FirstName: | D | ||||||||
| MiddleName: | HODARI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 CIRCLE 75 PKWY SE | ||||||||
| Address2: | SUITE 1700 | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303393035 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709536929 | ||||||||
| FaxNumber: | 7709536972 | ||||||||
| Practice Location | |||||||||
| Address1: | 3672 MARATHON CIR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | AUSTELL | ||||||||
| State: | GA | ||||||||
| PostalCode: | 301066821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7709443303 | ||||||||
| FaxNumber: | 7709440285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2005 | ||||||||
| LastUpdateDate: | 11/13/2014 | ||||||||
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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 | 207XS0114X | 056090 | GA | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207X00000X | 056090 | GA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 056090 | 01 | GA | LICENSE | OTHER |