MEDICARE: DR. SHERRI MARIE BROADWATER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0804X	Child & Adolescent Psychiatry Physician	M7633	TX
2	2084P0800X	Psychiatry Physician	67942	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932394798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERRI MARIE BROADWATER MD

Provider Business Mailing Address
First Line	:	3622 MAIN ST
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30337-2721
Country	:	US
Telephone Number	:	404-458-0382
Fax Number	:	678-335-2480

Provider Business Practice Location Address
First Line	:	3622 MAIN ST
Second Line	:
City	:	COLLEGE PARK
State	:	GA
Zip	:	30337-2721
Country	:	US
Telephone Number	:	404-458-0382
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/13/2007
Last Update Date	:	02/19/2024

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