Provider Demographics
NPI:1568563914
Name:HURWITZ, EUGENE STANLEY (MD)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:STANLEY
Last Name:HURWITZ
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 1:690 DALLAS HWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-1262
Mailing Address - Country:US
Mailing Address - Phone:770-459-0620
Mailing Address - Fax:770-465-7604
Practice Address - Street 1:690 DALLAS HWY
Practice Address - Street 2:SUITE 101
Practice Address - City:VILLA RICA
Practice Address - State:GA
Practice Address - Zip Code:30180-1209
Practice Address - Country:US
Practice Address - Phone:770-459-0620
Practice Address - Fax:770-836-4954
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA024694207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA03BDBRMMedicare ID - Type Unspecified
GAF33495Medicare UPIN