Provider Demographics
NPI:1295276996
Name:EIDSON, ERICA BROOKE (PA)
Entity type:Individual
Prefix:MS
First Name:ERICA
Middle Name:BROOKE
Last Name:EIDSON
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:1800 HOWELL MILL ROAD NW
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-2508
Mailing Address - Country:US
Mailing Address - Phone:404-355-4393
Mailing Address - Fax:678-412-0086
Practice Address - Street 1:1800 HOWELL MILL ROAD NW
Practice Address - Street 2:SUITE 450
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-2508
Practice Address - Country:US
Practice Address - Phone:404-355-4393
Practice Address - Fax:678-412-0086
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2018-02-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA8296363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAGRP586Medicare PIN