Provider Demographics
NPI:1568468403
Name:EUBANKS, TAJ (MD)
Entity Type:Individual
Prefix:
First Name:TAJ
Middle Name:
Last Name:EUBANKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5835 CAMPBELLTON RD SW STE 204
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-8014
Mailing Address - Country:US
Mailing Address - Phone:404-376-3639
Mailing Address - Fax:404-393-7828
Practice Address - Street 1:5835 CAMPBELLTON RD SW STE 204
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30331-8014
Practice Address - Country:US
Practice Address - Phone:404-376-3639
Practice Address - Fax:404-393-7828
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA55206207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology