Individual provider Active NPI

Steven Allen Eubanks Jr., M.D.

  • Pediatrics Physician
  • Carrollton, GA
National Provider Identifier
1083651996
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
057608 Issued in GA
Practice address
148 Clinic Ave
Carrollton, GA 30117
Phone
(770) 838-8640
Fax
(770) 838-8650
NPI assigned
May 31, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 057608 GA Primary
Hospitalist Physician 208M00000X 057608 GA

Addresses

Primary practice location

148 Clinic Ave
Carrollton, GA 30117

Mailing address

119 Ambulance Dr
Suite 202
Carrollton, GA 30117-3857
Phone (770) 812-5905

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240227003395 GA Practitioner - Pediatric Medicine 5193160372 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
057608GAMDHospitalist Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tanner Medical Group Inc Pediatrics CurrentSince Jan 16, 2024 Accepting new patients
TMC Children's Healthcare of West Georgia PastSince Jan 16, 2024 Accepting new patients
Pediatrix Medical Group of Georgia, P.C. Past Accepting new patients

Locations

204 Allen Memorial Dr
Ste 203
Bremen, GA 30110
Phone (770) 812-2430

100 Greenway Blvd
Fl 2
Carrollton, GA 30117
Phone (770) 838-8710

119 Ambulance Dr
Ste 202
Carrollton, GA 30117
Phone (770) 838-8710

148 Clinic Ave
Carrollton, GA 30117
Phone (770) 824-2430

705 Dixie St
Carrollton, GA 30117
Phone (770) 812-9666

706 Dixie St
Ste 210
Carrollton, GA 30117
Phone (770) 812-8640

601 Dallas Hwy
Villa Rica, GA 30180
Phone (770) 456-3000

690 Dallas Hwy
Ste 207A
Villa Rica, GA 30180
Phone (770) 456-3646

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149033600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1083651996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "119 AMBULANCE DR",
            "address_2": "SUITE 202",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301173857",
            "telephone_number": "770-812-5905",
            "fax_number": "770-838-8563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "148 CLINIC AVE",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "30117",
            "telephone_number": "770-838-8640",
            "fax_number": "770-838-8650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EUBANKS",
        "first_name": "STEVEN",
        "middle_name": "ALLEN",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-31",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "GA",
            "license": "057608",
            "primary": true
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "GA",
            "license": "057608",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Carrollton, GA

Sources for this page

Verify at the official NPI Registry.