Broadwater, Stephen R

Broadwater, Stephen R is an individual health care provider with primary practice located at 587 Furys Ferry Rd , Martinez GA 30907-9059. He recently has 3 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Cardiovascular Disease, Allopathic & Osteopathic Physicians / Interventional Cardiology. Allopathic & Osteopathic Physicians / Interventional Cardiology is his primary health care specialty. Broadwater, Stephen R can be contacted via phone (706) 721-8623.

Contact Information

Primary practice address
587 Furys Ferry Rd Martinez GA 30907-9059
Phone: (706) 721-8623
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 050003 Georgia
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 50003 Georgia
Allopathic & Osteopathic Physicians / Interventional Cardiology 207RI0011X 50003 Georgia

Profile Details

NPI number 1083697478
LBN Legal business name Broadwater, Stephen R
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 21st, 2005
Last updated Apr 3rd, 2024 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083697478 NPPES
Georgia MEDICAID 000905154A

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