Healthcare Provider Details

I. General information

NPI: 1619937786
Provider Name (Legal Business Name): TODD BLAKE GREER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TODD GREER MD

II. Dates (important events)

Enumeration Date: 03/24/2006
Last Update Date: 02/15/2025
Certification Date: 02/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3805 CRESTWOOD PKWY NW STE 350
DULUTH GA
30096-7159
US

IV. Provider business mailing address

3820 NORTHDALE BLVD STE 201
TAMPA FL
33624-1893
US

V. Phone/Fax

Practice location:
  • Phone: 800-991-6117
  • Fax:
Mailing address:
  • Phone: 800-991-6117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number042261
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number036109001
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number042261
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number042261
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: