Provider Demographics
NPI:1568411361
Name:SOUTHWEST ATLANTA AMBULATORY FOOT AND ANKLE SURGICAL CENTER, INC.
Entity Type:Organization
Organization Name:SOUTHWEST ATLANTA AMBULATORY FOOT AND ANKLE SURGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TOBI
Authorized Official - Middle Name:F
Authorized Official - Last Name:TODD
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:404-349-0951
Mailing Address - Street 1:300 VILLAGE GREEN CIR SE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3476
Mailing Address - Country:US
Mailing Address - Phone:770-384-0284
Mailing Address - Fax:770-432-7638
Practice Address - Street 1:2950 STONE HOGAN RD
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2837
Practice Address - Country:US
Practice Address - Phone:404-349-0951
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA111092ASCAMedicare ID - Type Unspecified