Healthcare Provider Details

I. General information

NPI: 1083110977
Provider Name (Legal Business Name): MATTHEW SCOTT BROGGI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2018
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 MEDICAL DR NE STE 101
CARTERSVILLE GA
30121-8005
US

IV. Provider business mailing address

PO BOX 29822
BELFAST ME
04915-2050
US

V. Phone/Fax

Practice location:
  • Phone: 770-386-5221
  • Fax:
Mailing address:
  • Phone: 770-386-5221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number99152
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: