Provider Demographics
NPI:1265123509
Name:TODORUT, IOAN ADRIAN
Entity type:Individual
Prefix:
First Name:IOAN
Middle Name:ADRIAN
Last Name:TODORUT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3941 PINE GORGE CT
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-4502
Mailing Address - Country:US
Mailing Address - Phone:770-865-8647
Mailing Address - Fax:
Practice Address - Street 1:3941 PINE GORGE CT
Practice Address - Street 2:
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-4502
Practice Address - Country:US
Practice Address - Phone:770-865-8647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-17
Last Update Date:2024-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA11742363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant