Provider Demographics
NPI:1881751360
Name:GOETZ, EUNICE JEON (PA-C)
Entity type:Individual
Prefix:MRS
First Name:EUNICE
Middle Name:JEON
Last Name:GOETZ
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:EUNICE
Other - Middle Name:NAMI
Other - Last Name:JEON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:6300 HOSPITAL PKWY STE 145
Mailing Address - Street 2:
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30097-1828
Mailing Address - Country:US
Mailing Address - Phone:404-778-4898
Mailing Address - Fax:404-778-4006
Practice Address - Street 1:1365 CLIFTON ROAD
Practice Address - Street 2:SUITE B1400
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322
Practice Address - Country:US
Practice Address - Phone:404-778-4898
Practice Address - Fax:404-778-4006
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA051233363AM0700X
GA7430363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA123371Medicare PIN
Q29022Medicare UPIN