Individual
TOD H BETHEA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2578 HELEN HWY, CLEVELAND, GA 30528-2848
(770) 219-9260
Mailing address
PO BOX 742616, ATLANTA, GA 30374-2616
(770) 219-8420
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
042016
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000784638F
MEDICAID # QUICK CARE
GA
05
—
00784638E
—
GA
01
—
08CBCJS
QUICK CARE MEDICARE PIN
GA
Enumeration date
08/19/2005
Last updated
12/15/2020
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