Healthcare Provider Details

I. General information

NPI: 1275591067
Provider Name (Legal Business Name): ERIC DEAN MININBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2006
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 HOWELL MILL RD NW STE 800
ATLANTA GA
30318-0922
US

IV. Provider business mailing address

1800 HOWELL MILL RD NW STE 800
ATLANTA GA
30318-0922
US

V. Phone/Fax

Practice location:
  • Phone: 404-350-9853
  • Fax: 404-350-8407
Mailing address:
  • Phone: 404-350-9853
  • Fax: 404-477-1162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number052790
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: