Provider Demographics
NPI:1023297256
Name:EILEEN BYRD, DPM PC
Entity type:Organization
Organization Name:EILEEN BYRD, DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EILEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:BYRD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:678-860-9862
Mailing Address - Street 1:1136 CLEVELAND AVE
Mailing Address - Street 2:SUITE 305
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3618
Mailing Address - Country:US
Mailing Address - Phone:404-762-9221
Mailing Address - Fax:404-762-9223
Practice Address - Street 1:1136 CLEVELAND AVE
Practice Address - Street 2:SUITE 305
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3618
Practice Address - Country:US
Practice Address - Phone:404-762-9221
Practice Address - Fax:404-762-9223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPOD000786213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP4637OtherMEDICARE GROUP NUMBER
5572790001Medicare NSC