Individual
DR. NICOLE STACK BROERMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
462 ELMA G MILES PKWY, HINESVILLE, GA 31313-4000
(912) 369-9400
(912) 877-9438
Mailing address
PO BOX 919, HINESVILLE, GA 31310-0919
(912) 369-9400
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
47265
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
T74835
—
GA
Enumeration date
09/19/2005
Last updated
04/17/2018
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