Provider Demographics
NPI:1992569966
Name:TODD, BERNIKA ANITA NICOLE
Entity type:Individual
Prefix:
First Name:BERNIKA
Middle Name:ANITA NICOLE
Last Name:TODD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 CAMP CREEK PKWY SW BLDG 1400
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-6247
Mailing Address - Country:US
Mailing Address - Phone:800-814-9505
Mailing Address - Fax:
Practice Address - Street 1:4518 SWAN TRCE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30349-1664
Practice Address - Country:US
Practice Address - Phone:678-245-2514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy