Healthcare Provider Details

I. General information

NPI: 1700900263
Provider Name (Legal Business Name): ELI J PIATIGORSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 11/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 SHILOH RD
ALPHARETTA GA
30005-8347
US

IV. Provider business mailing address

6240 SHILOH RD
ALPHARETTA GA
30005-8347
US

V. Phone/Fax

Practice location:
  • Phone: 877-376-7284
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number45466
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberME 99524
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number246512-1
License Number StateNY
# 4
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number67728
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: