Healthcare Provider Details

I. General information

NPI: 1346224987
Provider Name (Legal Business Name): LAWRENCE E EPPELBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 PIEDMONT RD NE SUITE E
ATLANTA GA
30305-2783
US

IV. Provider business mailing address

2911 PIEDMONT RD N SUITE E
ATLANTA GA
80305
US

V. Phone/Fax

Practice location:
  • Phone: 404-365-0160
  • Fax: 404-365-0751
Mailing address:
  • Phone: 404-365-0160
  • Fax: 404-365-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number38830
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: