Provider Demographics
NPI:1215042510
Name:JARRELL, TODD S (MD)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:S
Last Name:JARRELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 13TH AVE
Mailing Address - Street 2:BUILDING A
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-1950
Mailing Address - Country:US
Mailing Address - Phone:706-323-4000
Mailing Address - Fax:706-323-4848
Practice Address - Street 1:1538 13TH AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-1950
Practice Address - Country:US
Practice Address - Phone:706-323-4000
Practice Address - Fax:706-323-4848
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA026565208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00368794DMedicaid
GAD29862Medicare UPIN
GA00368794DMedicaid