MEDICARE: EAMON K DUTTA 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	2084P0800X	Psychiatry Physician	046593	GA

General Provider Information

NPI Number	:	1396822979
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EAMON K DUTTA M.D.

Provider Business Mailing Address
First Line	:	2150 PEACHFORD RD
Second Line	:	STE A
City	:	ATLANTA
State	:	GA
Zip	:	30338-6521
Country	:	US
Telephone Number	:	770-674-0553
Fax Number	:	770-674-0554

Provider Business Practice Location Address
First Line	:	2150 PEACHFORD RD
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30338-6520
Country	:	US
Telephone Number	:	770-455-3200
Fax Number	:	770-458-1594

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/10/2024

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