Healthcare Provider Details

I. General information

NPI: 1154703098
Provider Name (Legal Business Name): KAREN BRODER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2015
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3367 BUFORD HWY NE SUITE 910
BROOKHAVEN GA
30329-1833
US

IV. Provider business mailing address

3367 BUFORD HWY NE SUITE 910
BROOKHAVEN GA
30329-1833
US

V. Phone/Fax

Practice location:
  • Phone: 678-843-8700
  • Fax:
Mailing address:
  • Phone: 678-843-8700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number43563
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: