Provider Demographics
NPI:1912077967
Name:SECURO, ANTHONY TODDE (MD)
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:TODDE
Last Name:SECURO
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 1:2009 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-7931
Mailing Address - Country:US
Mailing Address - Phone:706-320-0055
Mailing Address - Fax:706-576-5513
Practice Address - Street 1:2009 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-7931
Practice Address - Country:US
Practice Address - Phone:706-320-0055
Practice Address - Fax:706-576-5513
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA051736207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA051736OtherGA LICENSCE
GAH57207Medicare UPIN