Provider Demographics
NPI:1831298231
Name:BROOKS, COURTNEY C JR (MD)
Entity Type:Individual
Prefix:
First Name:COURTNEY
Middle Name:C
Last Name:BROOKS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 PROFESSIONAL DR STE 170
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8717
Mailing Address - Country:US
Mailing Address - Phone:770-962-6015
Mailing Address - Fax:
Practice Address - Street 1:600 PROFESSIONAL DR
Practice Address - Street 2:SUITE 170
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-7651
Practice Address - Country:US
Practice Address - Phone:770-962-6015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA025949207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDWGMMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER