Provider Demographics
NPI:1861514499
Name:DOCTORS EIDEX, PC
Entity type:Organization
Organization Name:DOCTORS EIDEX, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARSHALL
Authorized Official - Middle Name:F
Authorized Official - Last Name:EIDEX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:404-294-0702
Mailing Address - Street 1:487 WINN WAY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-1735
Mailing Address - Country:US
Mailing Address - Phone:404-294-0702
Mailing Address - Fax:404-299-7499
Practice Address - Street 1:487 WINN WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-1735
Practice Address - Country:US
Practice Address - Phone:404-294-0702
Practice Address - Fax:404-299-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP1078Medicare ID - Type UnspecifiedPRACTICE MEDICARE NUMBER