Healthcare Provider Details

I. General information

NPI: 1043369333
Provider Name (Legal Business Name): RUSSELL G EYMAN D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 CARL VINSON PKWY
WARNER ROBINS GA
31088-5831
US

IV. Provider business mailing address

225 CARL VINSON PKWY
WARNER ROBINS GA
31088-5831
US

V. Phone/Fax

Practice location:
  • Phone: 478-923-0232
  • Fax: 478-929-3382
Mailing address:
  • Phone: 478-923-0232
  • Fax: 478-929-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number7417
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: