Provider Demographics
NPI:1891845863
Name:PENDLETON, EUGENE BANKS III (MD)
Entity Type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:BANKS
Last Name:PENDLETON
Suffix:III
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 1:6 EXECUTIVE PARK DR NE
Mailing Address - Street 2:SUITE #10
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2221
Mailing Address - Country:US
Mailing Address - Phone:404-321-9900
Mailing Address - Fax:
Practice Address - Street 1:6 EXECUTIVE PARK DR NE
Practice Address - Street 2:SUITE #10
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2221
Practice Address - Country:US
Practice Address - Phone:404-321-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA016408207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000679401Medicaid
GAD30438Medicare UPIN