Provider Demographics
NPI:1588049977
Name:DAULTON E TODD JR MD PC
Entity type:Organization
Organization Name:DAULTON E TODD JR MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROPRIETOR
Authorized Official - Prefix:
Authorized Official - First Name:DAULTON
Authorized Official - Middle Name:E
Authorized Official - Last Name:TODD
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:770-781-6373
Mailing Address - Street 1:418 PIRKLE FERRY RD
Mailing Address - Street 2:STE 103
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-2529
Mailing Address - Country:US
Mailing Address - Phone:770-781-6373
Mailing Address - Fax:770-781-6381
Practice Address - Street 1:418 PIRKLE FERRY RD
Practice Address - Street 2:STE 103
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2529
Practice Address - Country:US
Practice Address - Phone:770-781-6373
Practice Address - Fax:770-781-6381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA029116207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA11BDVCFMedicare PIN
GAE01115Medicare UPIN