MEDICARE: EUGENE STANLEY HURWITZ 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	207K00000X	Allergy & Immunology Physician	024694	GA

General Provider Information

NPI Number	:	1568563914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EUGENE STANLEY HURWITZ MD

Provider Business Mailing Address
First Line	:	690 DALLAS HWY
Second Line	:	SUITE 101
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1262
Country	:	US
Telephone Number	:	770-459-0620
Fax Number	:	770-465-7604

Provider Business Practice Location Address
First Line	:	690 DALLAS HWY
Second Line	:	SUITE 101
City	:	VILLA RICA
State	:	GA
Zip	:	30180-1209
Country	:	US
Telephone Number	:	770-459-0620
Fax Number	:	770-836-4954

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

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	04/02/2014

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