Healthcare Provider Details

I. General information

NPI: 1780981282
Provider Name (Legal Business Name): MR. TODD LAMAR HYDE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2011
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 VINEVILLE AVE SUITE B
MACON GA
31204-1854
US

IV. Provider business mailing address

1058 WARWICK DR
MACON GA
31210-1540
US

V. Phone/Fax

Practice location:
  • Phone: 478-474-8040
  • Fax: 478-474-8048
Mailing address:
  • Phone: 478-474-8040
  • Fax: 478-474-8048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: