Provider Demographics
NPI:1194858613
Name:ENMON, CLEVELAND J (MD)
Entity Type:Individual
Prefix:
First Name:CLEVELAND
Middle Name:J
Last Name:ENMON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W PEACHTREE ST NW
Mailing Address - Street 2:UNIT 3408
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30308-3536
Mailing Address - Country:US
Mailing Address - Phone:626-202-8114
Mailing Address - Fax:
Practice Address - Street 1:400 W PEACHTREE ST NW
Practice Address - Street 2:UNIT 3408
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30308-3536
Practice Address - Country:US
Practice Address - Phone:626-202-8114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA93821207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine