Provider Demographics
NPI:1619323094
Name:RADCLIFF, EUNICE ELISE ANTOINETTE (MD)
Entity Type:Individual
Prefix:
First Name:EUNICE
Middle Name:ELISE ANTOINETTE
Last Name:RADCLIFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EUNICE
Other - Middle Name:ELISE ANTOINETTE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1422 CLEVELAND AVE
Mailing Address - Street 2:
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-6983
Mailing Address - Country:US
Mailing Address - Phone:404-766-3337
Mailing Address - Fax:404-766-1464
Practice Address - Street 1:1422 CLEVELAND AVE
Practice Address - Street 2:
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-6983
Practice Address - Country:US
Practice Address - Phone:404-766-3337
Practice Address - Fax:404-766-1464
Is Sole Proprietor?:No
Enumeration Date:2016-05-04
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL36600208000000X
390200000X
GA85546208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program