Healthcare Provider Details

I. General information

NPI: 1952450439
Provider Name (Legal Business Name): ANNE NEUBERT BROBST O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11460 JOHNS CREEK PKWY
JOHNS CREEK GA
30097-1518
US

IV. Provider business mailing address

11460 JOHNS CREEK PKWY
JOHNS CREEK GA
30097-1518
US

V. Phone/Fax

Practice location:
  • Phone: 678-415-3860
  • Fax: 678-415-1052
Mailing address:
  • Phone: 770-886-6925
  • Fax: 678-415-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT002213
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: