Provider Demographics
NPI:1083605281
Name:EGGERT, ANN E (MD)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:E
Last Name:EGGERT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12 EASTBROOK BND
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1530
Mailing Address - Country:US
Mailing Address - Phone:770-487-3330
Mailing Address - Fax:770-487-7736
Practice Address - Street 1:12 EASTBROOK BND
Practice Address - Street 2:
Practice Address - City:PEACHTREE CITY
Practice Address - State:GA
Practice Address - Zip Code:30269-1530
Practice Address - Country:US
Practice Address - Phone:770-487-3330
Practice Address - Fax:770-487-7736
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA0289722080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000813689AMedicaid