Provider Demographics
NPI:1902532161
Name:BRODIE, GEORGIA (LPN)
Entity Type:Individual
Prefix:
First Name:GEORGIA
Middle Name:
Last Name:BRODIE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 W PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NC
Mailing Address - Zip Code:27536-5954
Mailing Address - Country:US
Mailing Address - Phone:252-438-4145
Mailing Address - Fax:252-438-6405
Practice Address - Street 1:300 W PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NC
Practice Address - Zip Code:27536-5954
Practice Address - Country:US
Practice Address - Phone:252-438-4145
Practice Address - Fax:252-438-6405
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC034064164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse