Provider Demographics
NPI:1346324662
Name:BYRD, EILEEN (DPM)
Entity Type:Individual
Prefix:DR
First Name:EILEEN
Middle Name:
Last Name:BYRD
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 CHARTER OAKS LN
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-3324
Mailing Address - Country:US
Mailing Address - Phone:678-860-9862
Mailing Address - Fax:
Practice Address - Street 1:601 OLD NORCROSS RD STE B
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4311
Practice Address - Country:US
Practice Address - Phone:770-910-9554
Practice Address - Fax:770-910-9553
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000786213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000739131FMedicaid
GA000739131FMedicaid
U64359Medicare UPIN
5572790001Medicare NSC