Individual
DR. STEPHEN R BROADWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
587 FURYS FERRY RD, MARTINEZ, GA 30907-9059
(706) 721-8623
Mailing address
1120 15TH ST # OR6000, AUGUSTA, GA 30912-0004
(706) 721-3813
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
050003
GA
207RC0000X
Cardiovascular Disease Physician
50003
GA
207RI0011X
Interventional Cardiology Physician
Primary
50003
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000905154A
—
GA
Enumeration date
11/21/2005
Last updated
04/03/2024
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