Provider Demographics
NPI:1558564260
Name:DZIUBAN, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:DZIUBAN
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 1:1600 CLIFTON RD NE
Mailing Address - Street 2:MS E-04
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-4018
Mailing Address - Country:US
Mailing Address - Phone:404-718-8394
Mailing Address - Fax:
Practice Address - Street 1:1600 CLIFTON RD NE
Practice Address - Street 2:MS E-04
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-4018
Practice Address - Country:US
Practice Address - Phone:404-718-8394
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA68892208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics