Provider Demographics
NPI:1619937786
Name:GREER, TODD BLAKE (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:BLAKE
Last Name:GREER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:TODD
Other - Middle Name:
Other - Last Name:GREER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:3820 NORTHDALE BLVD STE 201
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1893
Mailing Address - Country:US
Mailing Address - Phone:800-991-6117
Mailing Address - Fax:
Practice Address - Street 1:3805 CRESTWOOD PKWY NW STE 350
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-7159
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2025-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA042261202K00000X, 2086S0129X, 207R00000X
IL0361090012086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G35876Medicare UPIN
GA76BBBBHMedicare PIN