Provider Demographics
NPI:1588651632
Name:OLMEDO, EDUARDO J (MD)
Entity Type:Individual
Prefix:DR
First Name:EDUARDO
Middle Name:J
Last Name:OLMEDO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2041 MESA VALLEY WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-8157
Mailing Address - Country:US
Mailing Address - Phone:770-944-1100
Mailing Address - Fax:770-944-6469
Practice Address - Street 1:2041 MESA VALLEY WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-8157
Practice Address - Country:US
Practice Address - Phone:770-944-1100
Practice Address - Fax:770-944-6469
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2017-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA034036207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000457058HMedicaid
GA000457058CMedicaid
GA000457058FMedicaid
GA000457058BMedicaid
GA000457058FMedicaid
GA000457058CMedicaid