MEDICARE: DR. ANTHONY TODDE SECURO MD

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	207Q00000X	Family Medicine Physician	051736	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	051736	OTHER	GA	GA LICENSCE

General Provider Information

NPI Number	:	1912077967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY TODDE SECURO MD

Provider Business Mailing Address
First Line	:	2009 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-7931
Country	:	US
Telephone Number	:	706-320-0055
Fax Number	:	706-576-5513

Provider Business Practice Location Address
First Line	:	2009 WARM SPRINGS RD
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31904-7931
Country	:	US
Telephone Number	:	706-320-0055
Fax Number	:	706-576-5513

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	09/20/2016

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