Provider Demographics
NPI:1598860942
Name:BROSKY, THOMAS ANTHONY II (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANTHONY
Last Name:BROSKY
Suffix:II
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 MUNDY MILL PL STE A
Mailing Address - Street 2:
Mailing Address - City:OAKWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30566-2573
Mailing Address - Country:US
Mailing Address - Phone:770-536-7008
Mailing Address - Fax:770-536-1550
Practice Address - Street 1:4220 MUNDY MILL PL STE A
Practice Address - Street 2:
Practice Address - City:OAKWOOD
Practice Address - State:GA
Practice Address - Zip Code:30566-2573
Practice Address - Country:US
Practice Address - Phone:770-536-7008
Practice Address - Fax:770-536-1550
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2011-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000893213E00000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00893439IMedicaid
U81008Medicare UPIN
GA00893439IMedicaid