Healthcare Provider Details

I. General information

NPI: 1992838718
Provider Name (Legal Business Name): THEODORE JOSEPH ANFINSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 11/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 WINN WAY
DECATUR GA
30030-1715
US

IV. Provider business mailing address

450 WINN WAY
DECATUR GA
30030-1715
US

V. Phone/Fax

Practice location:
  • Phone: 404-294-0499
  • Fax: 404-508-6421
Mailing address:
  • Phone: 404-294-0499
  • Fax: 404-508-6421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number36915
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number36915
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: