MEDICARE: EMILY EAVES

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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1376412577
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY EAVES

Provider Business Mailing Address
First Line	:	3464 ROXBORO RD NE UNIT 1106
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-3386
Country	:	US
Telephone Number	:	270-938-3886
Fax Number	:

Provider Business Practice Location Address
First Line	:	3464 ROXBORO RD NE UNIT 1106
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30326-3386
Country	:	US
Telephone Number	:	270-938-3886
Fax Number	:

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

Provider Enumeration Date	:	11/04/2025
Last Update Date	:	11/04/2025

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Directions to “ EMILY EAVES ” Practice Location

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