Provider Demographics
NPI:1386690972
Name:TOLAND, ALAIN DANIEL (DO)
Entity type:Individual
Prefix:
First Name:ALAIN
Middle Name:DANIEL
Last Name:TOLAND
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 RUSSELL PKWY
Mailing Address - Street 2:BLDG 300, SUITE 301
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5763
Mailing Address - Country:US
Mailing Address - Phone:478-923-0106
Mailing Address - Fax:478-922-5211
Practice Address - Street 1:1719 RUSSELL PKWY
Practice Address - Street 2:BLDG 300, SUITE 301
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5763
Practice Address - Country:US
Practice Address - Phone:478-923-0106
Practice Address - Fax:478-922-5211
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA22901207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAF02897Medicare UPIN
GAGRP24Medicare ID - Type UnspecifiedOFFICE GROUP PROV #