Provider Demographics
NPI:1154703098
Name:BRODER, KAREN (MD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:BRODER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3367 BUFORD HWY NE
Mailing Address - Street 2:SUITE 910
Mailing Address - City:BROOKHAVEN
Mailing Address - State:GA
Mailing Address - Zip Code:30329-1833
Mailing Address - Country:US
Mailing Address - Phone:678-843-8700
Mailing Address - Fax:
Practice Address - Street 1:3367 BUFORD HWY NE
Practice Address - Street 2:SUITE 910
Practice Address - City:BROOKHAVEN
Practice Address - State:GA
Practice Address - Zip Code:30329-1833
Practice Address - Country:US
Practice Address - Phone:678-843-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA43563208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GABB5501398OtherDEA NUMBER