Basic Information
| Provider Information | |||||||||
| NPI: | 1629137302 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRODEUR | ||||||||
| FirstName: | DAVID | ||||||||
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| Credential: | MD PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 522 GRANT ST SE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303123116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4045233620 | ||||||||
| FaxNumber: | 8662625831 | ||||||||
| Practice Location | |||||||||
| Address1: | 2525 CUMBERLAND PKWY SE | ||||||||
| Address2: | FOURTH FLOOR - SUITE K | ||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303393915 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7704314360 | ||||||||
| FaxNumber: | 7704314350 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2006 | ||||||||
| LastUpdateDate: | 02/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 037964 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
No ID Information.