Provider Demographics
NPI:1053463174
Name:IRBY, ERIC (CERT FIRST ASSIST)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:IRBY
Suffix:
Gender:M
Credentials:CERT FIRST ASSIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3235
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30061-3235
Mailing Address - Country:US
Mailing Address - Phone:770-614-4711
Mailing Address - Fax:770-427-6396
Practice Address - Street 1:859 ECTOR CHASE NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-4788
Practice Address - Country:US
Practice Address - Phone:770-614-4177
Practice Address - Fax:770-427-6396
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GACSA 2852 CERTIFICATE246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA582625656OtherTAX ID