Provider Demographics
NPI:1740267640
Name:SOLOMON, ERIC DAVID (DO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:DAVID
Last Name:SOLOMON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1395 S MARIETTA PKWY SE
Mailing Address - Street 2:BLDG 100 STE 102
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4440
Mailing Address - Country:US
Mailing Address - Phone:770-425-8700
Mailing Address - Fax:770-425-8740
Practice Address - Street 1:1395 S MARIETTA PKWY SE
Practice Address - Street 2:BLDG 100 STE 102
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4440
Practice Address - Country:US
Practice Address - Phone:770-425-8700
Practice Address - Fax:770-425-8740
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA046649208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00809751AMedicaid
GA00809751AMedicaid
GA00809751AMedicaid