Healthcare Provider Details

I. General information

NPI: 1083651996
Provider Name (Legal Business Name): STEVEN ALLEN EUBANKS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

148 CLINIC AVE
CARROLLTON GA
30117
US

IV. Provider business mailing address

119 AMBULANCE DR SUITE 202
CARROLLTON GA
30117-3857
US

V. Phone/Fax

Practice location:
  • Phone: 770-838-8640
  • Fax: 770-838-8650
Mailing address:
  • Phone: 770-812-5905
  • Fax: 770-838-8563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number057608
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number057608
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: