Provider Demographics
NPI:1558456863
Name:BRIAN S BORTNICK, M.D., PC
Entity Type:Organization
Organization Name:BRIAN S BORTNICK, M.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CERTIFIED PSYCHIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:BORTNICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-847-9560
Mailing Address - Street 1:810 BROOKRIDGE DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3619
Mailing Address - Country:US
Mailing Address - Phone:404-847-9560
Mailing Address - Fax:404-847-9537
Practice Address - Street 1:18 LENOX POINTE NE STE A
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30324-7402
Practice Address - Country:US
Practice Address - Phone:404-847-9560
Practice Address - Fax:404-847-9537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0392942084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty