Provider Demographics
NPI:1932256120
Name:TODD, DOROTHY ELIZABETH (RN)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:ELIZABETH
Last Name:TODD
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 BLEEKER ST
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30044-4909
Mailing Address - Country:US
Mailing Address - Phone:770-609-6976
Mailing Address - Fax:
Practice Address - Street 1:3005 LENORA CHURCH RD
Practice Address - Street 2:BLDG. A
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-3688
Practice Address - Country:US
Practice Address - Phone:770-979-9157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN124606163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult