Provider Demographics
NPI:1952346702
Name:PFAFF, EUGENE DAVID (ATC)
Entity Type:Individual
Prefix:
First Name:EUGENE
Middle Name:DAVID
Last Name:PFAFF
Suffix:
Gender:M
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 HOLLAND PL
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-8636
Mailing Address - Country:US
Mailing Address - Phone:770-338-1740
Mailing Address - Fax:
Practice Address - Street 1:3625 BRASELTON HWY
Practice Address - Street 2:SUITE 204
Practice Address - City:DACULA
Practice Address - State:GA
Practice Address - Zip Code:30019-1014
Practice Address - Country:US
Practice Address - Phone:770-271-7492
Practice Address - Fax:770-271-7426
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAAT0002052255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer