Provider Demographics
NPI:1659577385
Name:EISELE, PAUL EMANUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:EMANUEL
Last Name:EISELE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1511 LONGLEAF DR
Mailing Address - Street 2:
Mailing Address - City:THOMASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:31792-7360
Mailing Address - Country:US
Mailing Address - Phone:229-226-9505
Mailing Address - Fax:229-228-9505
Practice Address - Street 1:1511 LONGLEAF DR
Practice Address - Street 2:
Practice Address - City:THOMASVILLE
Practice Address - State:GA
Practice Address - Zip Code:31792-7360
Practice Address - Country:US
Practice Address - Phone:229-226-9505
Practice Address - Fax:229-228-9505
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA014735207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAE99186Medicare UPIN