Doctor Name: | DR. STEPHEN R BROADWATER |
NPI Number: | 1083697478 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 050003 |
Business Practice Address: | 3614 J Dewey Gray Circle St A Augusta, GA - 30909 |
Business Phone Number: | 7069229222 |
Business Fax Number: | 7069225766 |
Mailing Address: | 818 Saint Sebastian Way, Ste 311 AUGUSTA |
State: | GA |
Postal Code: | 309012651 |
Phone Number: | 7067243473 |
Fax Number: | 7067243493 |
NPI Enumeration Date: | 11/21/2005 |
NPI Last Update Date: | 10/19/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 050003 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | GA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |