Individual
MISS ALYSSA BROADWATER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
5665 PEACHTREE DUNWOODY RD, ATLANTA, GA 30342-1764
(404) 778-7200
Mailing address
731 PAINT HORSE DR, CANTON, GA 30115-6817
(386) 405-8814
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
—
—
Other
Enumeration date
03/21/2020
Last updated
07/20/2020
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