Healthcare Provider Details

I. General information

NPI: 1598605883
Provider Name (Legal Business Name): EDUARDO MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 OAK HILL BLVD STE 100
NEWNAN GA
30265-2313
US

IV. Provider business mailing address

90 HIGH GARDEN TER
NEWNAN GA
30263-7000
US

V. Phone/Fax

Practice location:
  • Phone: 470-742-1832
  • Fax: 470-742-1833
Mailing address:
  • Phone: 470-742-1832
  • Fax: 470-742-1833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207QB0002X
TaxonomyObesity Medicine (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. ROGER EDUARDO
Title or Position: OWNER
Credential: MD
Phone: 203-500-3957