Provider Demographics
NPI:1770652471
Name:EMORY, EUGENE
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:
Last Name:EMORY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2858 PINE ST
Mailing Address - Street 2:
Mailing Address - City:UNADILLA
Mailing Address - State:GA
Mailing Address - Zip Code:31091-7700
Mailing Address - Country:US
Mailing Address - Phone:404-388-9968
Mailing Address - Fax:404-727-0372
Practice Address - Street 1:2858 PINE ST
Practice Address - Street 2:
Practice Address - City:UNADILLA
Practice Address - State:GA
Practice Address - Zip Code:31091-7700
Practice Address - Country:US
Practice Address - Phone:404-388-9968
Practice Address - Fax:404-727-0372
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-07
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY001197103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000378023DMedicaid