Provider Demographics
NPI:1942346507
Name:BRODIE, JOHN EDWARD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:BRODIE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3630 POINT COMFORT CLUB RD
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-9093
Mailing Address - Country:US
Mailing Address - Phone:706-868-6015
Mailing Address - Fax:706-364-8374
Practice Address - Street 1:128 N HOSPITAL RD
Practice Address - Street 2:CT SURGERY, 2ND FL CARDIOLOGY
Practice Address - City:FT. GORDON
Practice Address - State:GA
Practice Address - Zip Code:30905
Practice Address - Country:US
Practice Address - Phone:706-787-9231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant