Healthcare Provider Details

I. General information

NPI: 1568563914
Provider Name (Legal Business Name): EUGENE STANLEY HURWITZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

690 DALLAS HWY SUITE 101
VILLA RICA GA
30180-1209
US

IV. Provider business mailing address

690 DALLAS HWY SUITE 101
VILLA RICA GA
30180-1262
US

V. Phone/Fax

Practice location:
  • Phone: 770-459-0620
  • Fax: 770-836-4954
Mailing address:
  • Phone: 770-459-0620
  • Fax: 770-465-7604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number024694
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: