Provider Demographics
NPI:1750912143
Name:EISENBERG, JUDITH MICHELE
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:MICHELE
Last Name:EISENBERG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1090 TUSCULUM AVE
Mailing Address - Street 2:MS R-10
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45226-1938
Mailing Address - Country:US
Mailing Address - Phone:513-260-9986
Mailing Address - Fax:404-471-2722
Practice Address - Street 1:80 JESSE HILL JR DRIVE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30303
Practice Address - Country:US
Practice Address - Phone:404-251-8850
Practice Address - Fax:404-778-2630
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA83311207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine