Provider Demographics
NPI:1225003064
Name:HERRON, MARSHALL TODD (DPM)
Entity Type:Individual
Prefix:
First Name:MARSHALL
Middle Name:TODD
Last Name:HERRON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 CEDAR POINTE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-3339
Mailing Address - Country:US
Mailing Address - Phone:706-549-3668
Mailing Address - Fax:706-613-5069
Practice Address - Street 1:230 CEDAR POINTE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-3339
Practice Address - Country:US
Practice Address - Phone:706-549-3668
Practice Address - Fax:706-613-5069
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000733213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA480017437OtherRAILROAD MEDICARE
GA000627228BMedicaid
GA6521170OtherCIGNA
GA378560OtherWELLCARE
GA10076000OtherAMERIGROUP
GA1015170002OtherMEDICARE DMERC
GAU51090Medicare UPIN
GA480017437OtherRAILROAD MEDICARE