Provider Demographics
NPI:1225082506
Name:CABLE, TODD DALLAS (MD)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:DALLAS
Last Name:CABLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 N BELAIR RD STE 3E
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3191
Mailing Address - Country:US
Mailing Address - Phone:706-922-3747
Mailing Address - Fax:706-922-3751
Practice Address - Street 1:465 N BELAIR RD STE 3E
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3191
Practice Address - Country:US
Practice Address - Phone:706-922-3747
Practice Address - Fax:706-922-3751
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-20
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA046740208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000817396EMedicaid
SCG46470Medicaid
GA000817396GMedicaid
GAP00393586OtherRAILROAD MEDICARE
GAP00393586OtherRAILROAD MEDICARE
GA000817396GMedicaid