Provider Demographics
NPI:1699712109
Name:BROGDON, JOSEPH MILTON (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MILTON
Last Name:BROGDON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:389 MULBERRY ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31201-7914
Mailing Address - Country:US
Mailing Address - Phone:478-743-9123
Mailing Address - Fax:478-742-9809
Practice Address - Street 1:389 MULBERRY ST
Practice Address - Street 2:SUITE 200
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-7914
Practice Address - Country:US
Practice Address - Phone:478-743-9123
Practice Address - Fax:478-742-9809
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA227232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00232361CMedicaid
GAD39487Medicare UPIN