Provider Demographics
NPI:1437215571
Name:TODD, PHILLIP T (MED)
Entity Type:Individual
Prefix:MR
First Name:PHILLIP
Middle Name:T
Last Name:TODD
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8075 MALL PKWY
Mailing Address - Street 2:SUITE 101-334
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-6993
Mailing Address - Country:US
Mailing Address - Phone:404-944-6166
Mailing Address - Fax:770-322-0487
Practice Address - Street 1:8075 MALL PKWY
Practice Address - Street 2:SUITE 101-334
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-6993
Practice Address - Country:US
Practice Address - Phone:404-944-6166
Practice Address - Fax:770-322-0487
Is Sole Proprietor?:No
Enumeration Date:2006-12-30
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker