Provider Demographics
NPI:1376757856
Name:EISENMAN, DANIEL D (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:D
Last Name:EISENMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:705 JESSE JEWELL PKWY SE
Mailing Address - Street 2:SUITE 175
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3867
Mailing Address - Country:US
Mailing Address - Phone:770-718-9790
Mailing Address - Fax:770-718-5531
Practice Address - Street 1:705 JESSE JEWELL PKWY SE
Practice Address - Street 2:SUITE 175
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3867
Practice Address - Country:US
Practice Address - Phone:770-718-9790
Practice Address - Fax:770-718-5531
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2008-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GAPSY003084103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP7811OtherMEDICARE B
GA511I680050Medicare UPIN