Provider Demographics
NPI:1558858050
Name:HYMAN, BROOKE JILLIAN
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:JILLIAN
Last Name:HYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 KARYLOU DR
Mailing Address - Street 2:
Mailing Address - City:KINGSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21087-1014
Mailing Address - Country:US
Mailing Address - Phone:443-243-5623
Mailing Address - Fax:
Practice Address - Street 1:80 JESSE HILL JR DR SE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303-3031
Practice Address - Country:US
Practice Address - Phone:443-243-5623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MT115662207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program