Individual
EVAN M BRODY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
5205 STILESBORO RD NW STE 205, KENNESAW, GA 30152-7765
(678) 310-0540
(678) 310-0538
Mailing address
5205 STILESBORO RD NW STE 205, KENNESAW, GA 30152-7765
(678) 310-0540
(678) 310-0538
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
POD000937
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10055122
AMERIGROUP - MEDICAID
GA
01
—
1400101
GHI
GA
01
—
2700264
UNITED HEALTHCARE
GA
01
—
2701694
EVERCARE
GA
01
—
3262431
AETNA
GA
05
—
332208
—
GA
05
—
457858901A
—
GA
01
—
581994261
FIRST HEALTH
GA
01
—
6241458
CIGNA
GA
Enumeration date
02/20/2006
Last updated
07/21/2022
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