DR. GARY BROADNAX MD NPI 1033278361

NPI Information

NPI: 1033278361
Provider Name: DR. GARY BROADNAX, MD
Classification: Specialist - 174400000X
Entity Type: Individual
Address:
1289 BROAD ST
AUGUSTA, GA
ZIP 30901
Phone: (706) 724-5557
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DR. Gary Broadnax, MD is a specialist in Augusta, GA. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. DR. Gary Broadnax, MD NPI is 1033278361. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1289 BROAD ST
AUGUSTA, GA
ZIP 30901-187
Phone: (706) 724-5557
Fax: (706) 724-5293

The enumeration date for this NPI number is 12/6/2006 and was last updated on 11/12/2010.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist				Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	586045874	OTHER		HUMANA
2	G16213	OTHER	SOUTH CAROLINA	SOUTH CAROLINA MEDICAID
3	586045874	OTHER	GEORGIA	BCBS OF GEORGIA
4	586045874	OTHER	GEORGIA	AMERIGROUP COMMUNITY CARE
5	586045874	OTHER	GEORGIA	UNITED HEALTHCARE
6	586045874	OTHER	GEORGIA	CIGNA HEALTHCARE
7	586045874	OTHER	GEORGIA	PEACHSTATE HEALTH PLAN
8	586045874	OTHER		AETNA HEALTHCARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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