Provider Demographics
NPI:1578682944
Name:PROCTOR, ERICA N (MD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:N
Last Name:PROCTOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3855 PLEASANT HILL RD STE 280
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-8093
Mailing Address - Country:US
Mailing Address - Phone:678-312-7490
Mailing Address - Fax:678-312-7499
Practice Address - Street 1:3855 PLEASANT HILL RD STE 280
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-8093
Practice Address - Country:US
Practice Address - Phone:678-312-7490
Practice Address - Fax:678-312-7499
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301087755208600000X, 390200000X
GA86952208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program