Healthcare Provider Details

I. General information

NPI: 1639227739
Provider Name (Legal Business Name): MELISSA ANNE BROADMAN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 CHAPEL CROSSING RD # 390
BRUNSWICK GA
31524-2002
US

IV. Provider business mailing address

48 CANDLER DR
BRUNSWICK GA
31523-8239
US

V. Phone/Fax

Practice location:
  • Phone: 912-267-2322
  • Fax: 912-261-3724
Mailing address:
  • Phone: 248-884-1836
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5101014454
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number89342
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: