Provider Demographics
NPI:1679553689
Name:PRETORIUS, EUGENE S (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:S
Last Name:PRETORIUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3520 PIEDMONT RD NE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1516
Mailing Address - Country:US
Mailing Address - Phone:678-904-2590
Mailing Address - Fax:404-419-6985
Practice Address - Street 1:3520 PIEDMONT RD NE
Practice Address - Street 2:SUITE 250
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1516
Practice Address - Country:US
Practice Address - Phone:678-904-2590
Practice Address - Fax:404-419-6985
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0548212085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAP00353689OtherRAILROAD MEDICARE
GA770621142Medicaid
AZZ113889Medicare PIN
GAP00353689OtherRAILROAD MEDICARE
GAG92977Medicare UPIN
GA30BDLXQMedicare PIN