Healthcare Provider Details

I. General information

NPI: 1619323094
Provider Name (Legal Business Name): EUNICE ELISE ANTOINETTE RADCLIFF M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EUNICE ELISE ANTOINETTE DIXON MD

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 09/16/2020
Certification Date: 09/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1422 CLEVELAND AVE
EAST POINT GA
30344-6983
US

IV. Provider business mailing address

1422 CLEVELAND AVE
EAST POINT GA
30344-6983
US

V. Phone/Fax

Practice location:
  • Phone: 404-766-3337
  • Fax: 404-766-1464
Mailing address:
  • Phone: 404-766-3337
  • Fax: 404-766-1464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number36600
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number85546
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: