MEDICARE: CLEVELAND J ENMON M.D.

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	207P00000X	Emergency Medicine Physician	A93821	CA

General Provider Information

NPI Number	:	1194858613
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLEVELAND J ENMON M.D.

Provider Business Mailing Address
First Line	:	400 W PEACHTREE ST NW
Second Line	:	UNIT 3408
City	:	ATLANTA
State	:	GA
Zip	:	30308-3536
Country	:	US
Telephone Number	:	626-202-8114
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 W PEACHTREE ST NW
Second Line	:	UNIT 3408
City	:	ATLANTA
State	:	GA
Zip	:	30308-3536
Country	:	US
Telephone Number	:	626-202-8114
Fax Number	:

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

Provider Enumeration Date	:	03/13/2007
Last Update Date	:	05/02/2008

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