Provider Demographics
NPI:1710953088
Name:GRUEN, ERIC D (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:GRUEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DAWSON COMMONS CIR STE 420
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6269
Mailing Address - Country:US
Mailing Address - Phone:706-216-8637
Mailing Address - Fax:815-550-9967
Practice Address - Street 1:400 DAWSON COMMONS CIR STE 420
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534
Practice Address - Country:US
Practice Address - Phone:706-216-8637
Practice Address - Fax:815-550-9967
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-27
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYN004948213E00000X
GAPOD000924213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4418670001OtherDMERC NUMBER
GA000925878AMedicaid
GAPOD000924OtherPODIATRY LICENSE
GA48SCCHJMedicare ID - Type UnspecifiedGEORGIA MEDICARE NUMBER
GAU24544Medicare UPIN