Provider Demographics
NPI:1528072634
Name:BANK, ESTELLE R (MD)
Entity type:Individual
Prefix:DR
First Name:ESTELLE
Middle Name:R
Last Name:BANK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:SHELLI
Other - Middle Name:
Other - Last Name:BANK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:230 NORTHLAND RIDGE TRL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30342-2468
Mailing Address - Country:US
Mailing Address - Phone:404-257-0405
Mailing Address - Fax:
Practice Address - Street 1:THE EMORY CLINIC-RADIOLOGY
Practice Address - Street 2:1365 CLIFTON RD. NE - BLDG A
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-0001
Practice Address - Country:US
Practice Address - Phone:404-778-9729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA300032085P0229X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAA79745Medicare UPIN