Healthcare Provider Details

I. General information

NPI: 1235297599
Provider Name (Legal Business Name): TODD WILLIAM IWANICKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: TODD WILLIAM IWANICKI MD

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 PIEDMONT RD NE # 215
ATLANTA GA
30305-1506
US

IV. Provider business mailing address

3580 PIEDMONT RD NE # 215
ATLANTA GA
30305-1506
US

V. Phone/Fax

Practice location:
  • Phone: 404-800-5744
  • Fax: 404-777-2931
Mailing address:
  • Phone: 404-800-5744
  • Fax: 404-777-2931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number039598
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: