MEDICARE: TAJ EUBANKS M.D.

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	207L00000X	Anesthesiology Physician	55206	GA

General Provider Information

NPI Number	:	1568468403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAJ EUBANKS M.D.

Provider Business Mailing Address
First Line	:	5835 CAMPBELLTON RD SW STE 204
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8014
Country	:	US
Telephone Number	:	404-376-3639
Fax Number	:	404-393-7828

Provider Business Practice Location Address
First Line	:	5835 CAMPBELLTON RD SW STE 204
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30331-8014
Country	:	US
Telephone Number	:	404-376-3639
Fax Number	:	404-393-7828

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

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	10/31/2016

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