Provider Demographics
NPI:1659919264
Name:KURE, ERIC ALEXANDER
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ALEXANDER
Last Name:KURE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11900 WHITE BLUFF RD APT 1708
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31419-1541
Mailing Address - Country:US
Mailing Address - Phone:678-849-2589
Mailing Address - Fax:
Practice Address - Street 1:804 TOWNE PARK DR STE 400
Practice Address - Street 2:
Practice Address - City:RINCON
Practice Address - State:GA
Practice Address - Zip Code:31326-5153
Practice Address - Country:US
Practice Address - Phone:912-826-3797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2019-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0031792255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer