Provider Demographics
NPI:1427045319
Name:TODD, TOBI (DPM)
Entity Type:Individual
Prefix:
First Name:TOBI
Middle Name:
Last Name:TODD
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 1:5835 CAMPBELLTON RD SW
Mailing Address - Street 2:STE 201
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8014
Mailing Address - Country:US
Mailing Address - Phone:404-906-6466
Mailing Address - Fax:
Practice Address - Street 1:5835 CAMPBELLTON RD SW
Practice Address - Street 2:STE 201
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8014
Practice Address - Country:US
Practice Address - Phone:404-906-6466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000972213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA847406400AOtherPEACH STATE HEALTH PLAN
GA847406400DMedicaid
GA847406400AMedicaid
GA847406400CMedicaid
GA314296OtherWELLCARE MEDICAID
GA7915649OtherAETNA
GA10039291OtherAMERIGROUP, MEDICAID
GA847406400DOtherPEACH STATE HEALTH PLAN
GA847406400DOtherPEACH STATE HEALTH PLAN
GA7915649OtherAETNA
GAP00434494Medicare PIN
GA48SCCMHMedicare PIN