Provider Demographics
NPI:1598714073
Name:ANTIN, TODD MITCHELL (MD)
Entity Type:Individual
Prefix:DR
First Name:TODD
Middle Name:MITCHELL
Last Name:ANTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 WINN WAY
Mailing Address - Street 2:SUITE 221
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1753
Mailing Address - Country:US
Mailing Address - Phone:404-663-4029
Mailing Address - Fax:404-292-3848
Practice Address - Street 1:465 WINN WAY
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1753
Practice Address - Country:US
Practice Address - Phone:404-663-4029
Practice Address - Fax:404-292-3848
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-10
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0364952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA26BDFRVMedicare ID - Type Unspecified
GAF63434Medicare UPIN