Basic Information
| Provider Information | |||||||||
| NPI: | 1437232634 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PAUL | ||||||||
| FirstName: | EUGENE | ||||||||
| MiddleName: | ANTHONY | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | SR. | ||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PAUL | ||||||||
| OtherFirstName: | EUGENE | ||||||||
| OtherMiddleName: | A. | ||||||||
| OtherNamePrefix: | DR. | ||||||||
| OtherNameSuffix: | SR. | ||||||||
| OtherCredential: | MD | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 8390 CHAMPIONS GATE BLVD | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | CHAMPIONS GATE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338968310 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073901677 | ||||||||
| FaxNumber: | 4073901765 | ||||||||
| Practice Location | |||||||||
| Address1: | 1605 PEACHTREE ST NE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303092433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4048707746 | ||||||||
| FaxNumber: | 4048707719 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 07/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 60305 | GA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.