Provider Demographics
NPI:1346265402
Name:TODD, ANNE BERRY (MD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:BERRY
Last Name:TODD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 HIGHLAND PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:EAST ELLIJAY
Mailing Address - State:GA
Mailing Address - Zip Code:30540-7657
Mailing Address - Country:US
Mailing Address - Phone:706-698-8400
Mailing Address - Fax:706-698-8401
Practice Address - Street 1:433 HIGHLAND PKWY STE 101
Practice Address - Street 2:
Practice Address - City:EAST ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30540-7657
Practice Address - Country:US
Practice Address - Phone:706-698-8400
Practice Address - Fax:706-698-8401
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051395207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000236519BMedicaid
GA528172817JMedicaid
GA528172817IMedicaid
GA000236519BMedicaid
GA528172817JMedicaid
GA20208I6588Medicare PIN