Healthcare Provider Details

I. General information

NPI: 1902917727
Provider Name (Legal Business Name): ERIC B ATWOOD D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 11/06/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 SCHWEGLER DR RM 2100
LAWRENCE KS
66045-1963
US

IV. Provider business mailing address

1200 SCHWEGLER DR RM 2100
LAWRENCE KS
66045-7538
US

V. Phone/Fax

Practice location:
  • Phone: 785-864-2277
  • Fax: 785-864-2721
Mailing address:
  • Phone: 785-864-2277
  • Fax: 785-864-2721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number05-21953
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number521953
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: