Individual
DR. SHIRLEY EUGENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
1438 W PEACHTREE ST NW, ATLANTA, GA 30309-2998
(470) 283-7349
(833) 689-2507
Mailing address
6255 W SUNSET BLVD FL 21, LOS ANGELES, CA 90028-7422
(323) 860-5200
(323) 467-7119
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4230
IA
207Q00000X
Family Medicine Physician
Primary
72238
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1891951349
WELLMARK BLUE CROSS BLUES SHIELD
IA
05
—
1891951349
—
IA
Enumeration date
08/04/2008
Last updated
05/06/2024
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