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General NPI Number Information
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NPI Number | 1891073797
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Entity Type | Organization
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Legal Business Name | DANIEL EISENMAN LLC
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Dates
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Enumeration Date | 07/26/2011
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Last Update Date | 11/10/2015
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Provider Practice Location Address
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Address Line | 11030 JONES BRIDGE RD SUITE 203
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City | JOHNS CREEK
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State | GA
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Zip | 30022-4560
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Country | US
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Telephone | 678-263-8512
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Fax | 678-298-9997
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Provider Business Mailing Address
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Address Line | 11030 JONES BRIDGE RD SUITE 203
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City | JOHNS CREEK
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State | GA
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Zip | 30022-4560
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Country | US
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Telephone | 678-263-8512
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Fax | 678-298-9997
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Authorized Official
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Title or Position | OWNER
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Name | DANIEL D EISENMAN
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Credential | PH.D.
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Telephone | 678-263-8512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY003084
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License Number State | GA
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