MEDICARE: DANA RACHAEL EYERLY MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	ME168605	FL

General Provider Information

NPI Number	:	1184201758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA RACHAEL EYERLY MD

Provider Business Mailing Address
First Line	:	PO BOX 746638
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6638
Country	:	US
Telephone Number	:	904-202-1032
Fax Number	:	904-376-4107

Provider Business Practice Location Address
First Line	:	950 MARSH LANDING PKWY STE 105A
Second Line	:
City	:	JACKSONVILLE BEACH
State	:	FL
Zip	:	32250-1408
Country	:	US
Telephone Number	:	904-280-1225
Fax Number	:	904-390-7505

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2021
Last Update Date	:	06/14/2024

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