Provider Demographics
NPI:1215486469
Name:TODD D CABLE M.D., LLC
Entity type:Organization
Organization Name:TODD D CABLE M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:D
Authorized Official - Last Name:CABLE
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:706-231-7131
Mailing Address - Street 1:588 LINKS LN
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-8958
Mailing Address - Country:US
Mailing Address - Phone:706-231-7131
Mailing Address - Fax:
Practice Address - Street 1:588 LINKS LN
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-8958
Practice Address - Country:US
Practice Address - Phone:706-231-7131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-29
Last Update Date:2016-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046740207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000817396GMedicaid
GA000817396GMedicaid
GA30BDNLWMedicare PIN