Provider Demographics
NPI:1588277867
Name:BROGDON, SALETA ANICA (ARNP)
Entity type:Individual
Prefix:
First Name:SALETA
Middle Name:ANICA
Last Name:BROGDON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MUIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30016-6536
Mailing Address - Country:US
Mailing Address - Phone:404-641-6237
Mailing Address - Fax:678-806-4803
Practice Address - Street 1:10 MUIRFIELD DR
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:GA
Practice Address - Zip Code:30016-6536
Practice Address - Country:US
Practice Address - Phone:404-641-6237
Practice Address - Fax:678-806-4803
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN197303363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology