Provider Demographics
NPI:1295996155
Name:GREENBRIAR FOOT & ANKLE CENTER
Entity type:Organization
Organization Name:GREENBRIAR FOOT & ANKLE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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:404-349-5100
Mailing Address - Street 1:300 VILLAGE GREEN CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SMYRNA
Mailing Address - State:GA
Mailing Address - Zip Code:30080-3451
Mailing Address - Country:US
Mailing Address - Phone:770-384-0284
Mailing Address - Fax:
Practice Address - Street 1:2950 STONE HOGAN RD CONN SW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-2885
Practice Address - Country:US
Practice Address - Phone:404-349-5100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-23
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4916000001Medicare NSC