Michlene Broadney, MD

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

055207 Issued in GA

Practice address

1279 Highway 54 W
Suite 220
Fayetteville, GA 30214-4552

Phone

(770) 991-2200

Fax

(770) 991-1341

NPI assigned

Sep 12, 2005

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southern Crescent Women'S Healthcare PC

  • Obstetrics & Gynecology Physician
  • Fayetteville, GA
  • NPI 1427061589
  Medicare reassignment NPD
• Southern Regional Health System, Inc

  • General Acute Care Hospital
  • Riverdale, GA
  • NPI 1831190958
  NPD (past)
• Women'S Community Care, PC

  • Gynecology Physician
  • Fayetteville, GA
  • NPI 1417167446
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1319241600000",
    "number": "1629062153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1279 HIGHWAY 54 W",
            "address_2": "SUITE 220",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144552",
            "telephone_number": "770-991-2200",
            "fax_number": "770-991-1341"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1279 HIGHWAY 54 W",
            "address_2": "SUITE 220",
            "city": "FAYETTEVILLE",
            "state": "GA",
            "postal_code": "302144552",
            "telephone_number": "770-991-2200",
            "fax_number": "770-991-1341"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADNEY",
        "first_name": "MICHLENE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-09-12",
        "last_updated": "2011-10-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "GA",
            "license": "055207",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253338437B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "253338437A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Avery Lawyer Brewer, MS, LPC
• Bridge Medical Supply Corp
• Deborah Bridgeman
• Constance Bright, NP-C
• Brightheart Home Care Inc
• Broken Branches Counseling, LLC
• Brittany Broncatello, RBT
• Chloe Parese Brooks
• Linda Louise Brown Roberson, LPC,CPCS,CAC-II,CCS
• Cicely Kinisha Brown, NP

• Obstetrics & Gynecology Physician in Fayetteville, GA
• Providers in Fayetteville, GA by specialty
• Obstetrics & Gynecology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.