Provider Demographics
NPI:1740560812
Name:EUGENIO-COLON, JOSE D (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:D
Last Name:EUGENIO-COLON
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 1:6105 PEACHTREE DUNWOODY RD STE B230
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5928
Mailing Address - Country:US
Mailing Address - Phone:770-913-0001
Mailing Address - Fax:770-913-0005
Practice Address - Street 1:6105 PEACHTREE DUNWOODY RD STE B230
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30328-5928
Practice Address - Country:US
Practice Address - Phone:770-913-0001
Practice Address - Fax:770-913-0005
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-22
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD13764207V00000X
390200000X
GA77619207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program