Basic Information
| Provider Information | |||||||||
| NPI: | 1750912143 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | EISENBERG | ||||||||
| FirstName: | JUDITH | ||||||||
| MiddleName: | MICHELE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1090 TUSCULUM AVE | ||||||||
| Address2: | MS R-10 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452261938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5132609986 | ||||||||
| FaxNumber: | 4044712722 | ||||||||
| Practice Location | |||||||||
| Address1: | 80 JESSE HILL JR DRIVE | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 30303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4042518850 | ||||||||
| FaxNumber: | 4047782630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2020 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 83311 | GA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.