Healthcare Provider Details

I. General information

NPI: 1770652471
Provider Name (Legal Business Name): EUGENE EMORY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 01/03/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2858 PINE ST
UNADILLA GA
31091-7700
US

IV. Provider business mailing address

2858 PINE ST
UNADILLA GA
31091-7700
US

V. Phone/Fax

Practice location:
  • Phone: 404-388-9968
  • Fax: 404-727-0372
Mailing address:
  • Phone: 404-388-9968
  • Fax: 404-727-0372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY001197
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: