Healthcare Provider Details

I. General information

NPI: 1740560812
Provider Name (Legal Business Name): JOSE D EUGENIO-COLON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6105 PEACHTREE DUNWOODY RD STE B230
ATLANTA GA
30328-5928
US

IV. Provider business mailing address

6105 PEACHTREE DUNWOODY RD STE B230
ATLANTA GA
30328-5928
US

V. Phone/Fax

Practice location:
  • Phone: 770-913-0001
  • Fax: 770-913-0005
Mailing address:
  • Phone: 770-913-0001
  • Fax: 770-913-0005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD13764
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number77619
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: