Healthcare Provider Details

I. General information

NPI: 1356417448
Provider Name (Legal Business Name): KITTY C BROGDON RN CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

99 JESSIE HILL JR DR SE
ATLANTA GA
30303
US

IV. Provider business mailing address

99 JESSE HILL JR DRIVE RM 402
ATLANTA GA
30303
US

V. Phone/Fax

Practice location:
  • Phone: 404-730-4029
  • Fax: 404-224-3105
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN040606
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN040606
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: