MEDICARE: SOUTHWEST ATLANTA AMBULATORY FOOT AND ANKLE SURGICAL CENTER, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1568411361
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHWEST ATLANTA AMBULATORY FOOT AND ANKLE SURGICAL CENTER, INC.

Provider Business Mailing Address
First Line	:	300 VILLAGE GREEN CIR SE
Second Line	:	SUITE 200
City	:	SMYRNA
State	:	GA
Zip	:	30080-3476
Country	:	US
Telephone Number	:	770-384-0284
Fax Number	:	770-432-7638

Provider Business Practice Location Address
First Line	:	2950 STONE HOGAN RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-2837
Country	:	US
Telephone Number	:	404-349-0951
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	TOBI F. TODD
Credential	:	D.P.M.
Telephone Number	:	404-349-0951

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	08/22/2020

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