Basic Information
| Provider Information | |||||||||
| NPI: | 1740584580 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOLEDO | ||||||||
| FirstName: | JODI | ||||||||
| MiddleName: | HENDERSON | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1800 NORTHSIDE FORSYTH DR | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300418416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708863555 | ||||||||
| FaxNumber: | 7702056501 | ||||||||
| Practice Location | |||||||||
| Address1: | 1800 NORTHSIDE FORSYTH DR | ||||||||
| Address2: | SUITE 350 | ||||||||
| City: | CUMMING | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300418416 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7708863555 | ||||||||
| FaxNumber: | 7702056501 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2011 | ||||||||
| LastUpdateDate: | 12/17/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN154366 | GA | N | Nursing Service Providers | Registered Nurse | 367A00000X | RN154366 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.