Provider Demographics
NPI:1053581009
Name:ERIC D. GRUEN D.P.M., P.C.
Entity type:Organization
Organization Name:ERIC D. GRUEN D.P.M., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARCOTTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-216-8637
Mailing Address - Street 1:400 DAWSON COMMONS CIR STE 420
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6269
Mailing Address - Country:US
Mailing Address - Phone:706-216-8637
Mailing Address - Fax:815-550-9967
Practice Address - Street 1:400 DAWSON COMMONS CIR STE 420
Practice Address - Street 2:
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6269
Practice Address - Country:US
Practice Address - Phone:706-216-8637
Practice Address - Fax:706-815-5509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4418670001Medicare NSC