Healthcare Provider Details

I. General information

NPI: 1750912143
Provider Name (Legal Business Name): JUDITH MICHELE EISENBERG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 JESSE HILL JR DRIVE
ATLANTA GA
30303
US

IV. Provider business mailing address

1090 TUSCULUM AVE MS R-10
CINCINNATI OH
45226-1938
US

V. Phone/Fax

Practice location:
  • Phone: 404-251-8850
  • Fax: 404-778-2630
Mailing address:
  • Phone: 513-260-9986
  • Fax: 404-471-2722

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number83311
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: