Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | 007567 | GA |
NPI | 1164510020 |
---|---|
Provider Name | Dr. Andrew Todd Addess |
First Address | Marietta, GA 30068-2114 |
Second Address | Marietta, GA 30068-2114 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2006 |
Last Update Date | 08/07/2007 |