Provider Demographics
NPI:1962720664
Name:MYERS, ELIZA A (DMD)
Entity type:Individual
Prefix:
First Name:ELIZA
Middle Name:A
Last Name:MYERS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MYRTLE BLVD
Mailing Address - Street 2:EAST CENTRAL REGIONAL HOSPITAL
Mailing Address - City:GRACEWOOD
Mailing Address - State:GA
Mailing Address - Zip Code:30812
Mailing Address - Country:US
Mailing Address - Phone:706-790-2144
Mailing Address - Fax:706-790-2326
Practice Address - Street 1:100 MYRTLE BLVD
Practice Address - Street 2:EAST CENTRAL REGIONAL HOSPITAL
Practice Address - City:GRACEWOOD
Practice Address - State:GA
Practice Address - Zip Code:30812
Practice Address - Country:US
Practice Address - Phone:706-790-2144
Practice Address - Fax:706-790-2326
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2010-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013940122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist