Provider Demographics
NPI:1427059856
Name:HERRINGTON, EUGENE (PHD)
Entity type:Individual
Prefix:DR
First Name:EUGENE
Middle Name:
Last Name:HERRINGTON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 EDWIN PL NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-4881
Mailing Address - Country:US
Mailing Address - Phone:404-792-1457
Mailing Address - Fax:
Practice Address - Street 1:60 EDWIN PL NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-4881
Practice Address - Country:US
Practice Address - Phone:404-792-1457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2020-01-22
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
GACSW0010351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA881938994AMedicaid