MISS ALYSSA BROADWATER (NPI# 1245866276) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1245866276 |
Entity Type | Individual |
Full Name | MISS ALYSSA BROADWATER |
Credential | PA-C |
Practice Address |
5665 Peachtree Dunwoody Rd Atlanta GA 30342-1764 |
Mailing Address |
731 Paint Horse Dr Canton GA 30115-6817 |
Practice Telephone | 4047787200 |
Mailing Telephone | 3864058814 |
Enumeration Date | 2020-03-21 |
Last Update Date | 2020-07-20 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
Physician Assistants & Advanced Practice Nursing Providers |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1063966984 | Alyssa Reau Broadwater | Dietitian, Registered | 4353 Tuller Rd Ste K, Dublin, OH 43017-5071 | 2016-08-09 |
Street Address |
5665 PEACHTREE DUNWOODY RD |
City | ATLANTA |
State | GA |
Zip Code | 30342-1764 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1235739376 | Joel John Varghese | Registered Nurse | 5665 Peachtree Dunwoody Rd, Atlanta, GA 30342-1764 | 2020-10-28 |
1942810130 | Alexander Douglas Yox | Anesthesiologist Assistant | 5665 Peachtree Dunwoody Rd, Atlanta, GA 30342-1764 | 2020-08-03 |
1265056352 | Julie Thi Quach | Nurse Practitioner | 5665 Peachtree Dunwoody Rd, Atlanta, GA 30342-1764 | 2020-06-03 |
1104462571 | Amanda Dostie | Registered Nurse | 5665 Peachtree Dunwoody Rd, Atlanta, GA 30342-1764 | 2019-11-20 |
1164067112 | Eltayeb Mohamed Ahmed | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 5665 Peachtree Dunwoody Rd, Atlanta, GA 30342-1764 | 2019-11-14 |
1104468826 | Leanna Nicole Hutto | Registered Nurse | 5665 Peachtree Dunwoody Rd, Atlanta, GA 30342-1764 | 2019-10-14 |
1083255376 | Katelyn Lott | Nurse Practitioner | 5665 Peachtree Dunwoody Rd, Atlanta, GA 30342-1764 | 2019-10-08 |
1033750278 | Marjorie Marilyn White | Nurse Practitioner | 5665 Peachtree Dunwoody Rd, Atlanta, GA 30342-1764 | 2019-09-29 |
1144872789 | Jeannie Stamps Aldridge | Anesthesiologist Assistant | 5665 Peachtree Dunwoody Rd, Atlanta, GA 30342-1764 | 2019-07-14 |
1881159192 | Sylvia Diana Sajna | Registered Nurse | 5665 Peachtree Dunwoody Rd, Atlanta, GA 30342-1764 | 2019-01-31 |
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NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1144820614 | Nia Charnice Griffin | Nurse Practitioner | 5670 Peachtree Dunwoodyroad, Suite 900, Atlanta, GA 30342 | 2020-10-26 |
1255945184 | Jennifer Lynne Cole | Behavior Technician | 5555 Glenridge Con Suite 200, Atlanta, GA 30342 | 2020-09-08 |
1093336232 | Van Tran | Respiratory Therapist, Registered | 1000 Johnson Ferry Rd Ne, Atlanta, Ga 30342, Atlanta, GA 30342 | 2020-04-28 |
1356978340 | Twyla Douglas Jackson I | Clinical Nutrition, 1000 Johnson Ferry Rd Ne, Atlanta, GA 30342 | 2020-03-27 | |
1760013411 | Emily Hamm | Dietitian, Registered | 933 D Johnson Ferry Road, Suite 250, Atlanta, GA 30342 | 2020-01-31 |
1043855984 | Mackenzie Tucker Wayda | Registered Nurse | 1001 Johnson Ferry Rd. Ne, Atlanta, GA 30342 | 2019-11-14 |
1386288454 | Tiauna Lashun Cochman | Psychologist | 1307 Glenridge Dr, Sandy Springs, GA 30342 | 2019-11-01 |
1164074399 | Stephen J. White | Hearing Instrument Specialist | 5775 Peachtree Dunwoody Rd Suite 600 Fl. 6, Uhc Hearing, Atl., GA 30342 | 2019-07-09 |
1144788142 | Jaytyn LLC | Internal Medicine | 4600 Broswell Road, Atlanta, GA 30342 | 2019-03-08 |
1760954705 | Mishele Walker LLC | Counselor | 555 Glenridge Connector, Suite 200, Sandy Springs, GA 30342 | 2018-12-31 |
Find all providers in zip 30342 |
Taxonomy Code | 363AS0400X |
Grouping | Physician Assistants & Advanced Practice Nursing Providers |
Classification | Physician Assistant |
Specialization | Surgical Technologist |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1912356775 | Jason Weddington | Physician Assistant | 5667 Peachtree Dunwoody Rd Ste 220, Atlanta, GA 30342-1725 | 2016-06-11 |
1578937181 | Vds Surgical Assistants, Inc. | Physician Assistant | 1307 W Garmon Rd, Atlanta, GA 30327-4405 | 2015-11-19 |
1407220379 | Simpson Surgery Group, LLC | Physician Assistant | 701 Highland Ave Ne Apt 1407, #1407, Atlanta, GA 30312-1454 | 2015-11-16 |
1417388232 | Tracey Lorena Tello | Physician Assistant | 931 Monroe Drive Ne, Suite 102 #641, Atlanta, GA 30308-7132 | 2013-12-04 |
1336587401 | Marissa B Highnote | Physician Assistant | 6045 Barfield Rd Ste 100, Atlanta, GA 30328-4402 | 2013-06-11 |
1396013223 | Signature Surgical Assistants | Physician Assistant | 2489 Kings Arms Dr Ne, Atlanta, GA 30345-2132 | 2011-12-07 |
1720364318 | Leah Strickland | Physician Assistant | 4279 Roswell Road Suite 102 Pmb 303, Atlanta, GA 30342 | 2011-10-26 |
1669798872 | Tiffiany Mccune | Physician Assistant | 4979 Lower Elm St, Atlanta, GA 30349-1677 | 2010-04-13 |
1306177233 | Hong Feng Shi | Physician Assistant | 4355 Cobb Pkwy Ste J131, Atlanta, GA 30339-3887 | 2010-01-15 |
1821256223 | Clyde D Johnson Jr. | Physician Assistant | 5881 Glendrige Dr Ne, Suite 120, Atlanta, GA 30328 | 2008-06-02 |
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Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.