Provider Demographics
NPI:1477711471
Name:LACKRITZ, EVE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:EVE
Middle Name:MARIE
Last Name:LACKRITZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 BUFORD HWY
Mailing Address - Street 2:CDC, MAILSTOP K-23
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3717
Mailing Address - Country:US
Mailing Address - Phone:770-488-6507
Mailing Address - Fax:770-488-6283
Practice Address - Street 1:2900 WOODCOCK BLVD
Practice Address - Street 2:COLUMBIA BUILDING, KOGER CENTER
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30341-4004
Practice Address - Country:US
Practice Address - Phone:770-488-6507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA38031208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics