Provider Demographics
NPI:1891073797
Name:DANIEL EISENMAN LLC
Entity type:Organization
Organization Name:DANIEL EISENMAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:EISENMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:678-263-8512
Mailing Address - Street 1:11030 JONES BRIDGE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:JOHNS CREEK
Mailing Address - State:GA
Mailing Address - Zip Code:30022-4560
Mailing Address - Country:US
Mailing Address - Phone:678-263-8512
Mailing Address - Fax:678-298-9997
Practice Address - Street 1:11030 JONES BRIDGE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:JOHNS CREEK
Practice Address - State:GA
Practice Address - Zip Code:30022-4560
Practice Address - Country:US
Practice Address - Phone:678-263-8512
Practice Address - Fax:678-298-9997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY003084103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty