Provider Demographics
NPI:1326357799
Name:SANIK, EUGENE (DO)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:SANIK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 HOSPITAL BLVD
Mailing Address - Street 2:SUITE 280
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-4907
Mailing Address - Country:US
Mailing Address - Phone:770-754-0787
Mailing Address - Fax:866-763-0787
Practice Address - Street 1:2500 HOSPITAL BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-4907
Practice Address - Country:US
Practice Address - Phone:770-754-0787
Practice Address - Fax:866-763-0787
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-01
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA70771207N00000X, 207Q00000X
FLOS11610207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine