Individual
MICHLENE BROADNEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1279 HIGHWAY 54 W, SUITE 220, FAYETTEVILLE, GA 30214-4552
(770) 991-2200
(770) 991-1341
Mailing address
1279 HIGHWAY 54 W, SUITE 220, FAYETTEVILLE, GA 30214-4552
(770) 991-2200
(770) 991-1341
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
055207
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
253338437A
—
GA
05
—
253338437B
—
GA
Enumeration date
09/12/2005
Last updated
10/22/2011
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