Provider Demographics
NPI:1033593629
Name:LIDER, YEVHENIY (MD)
Entity type:Individual
Prefix:
First Name:YEVHENIY
Middle Name:
Last Name:LIDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5665 NEW NORTHSIDE DR STE 320
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30328-5834
Mailing Address - Country:US
Mailing Address - Phone:404-265-4450
Mailing Address - Fax:
Practice Address - Street 1:620 N MAIN ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2911
Practice Address - Country:US
Practice Address - Phone:870-414-4000
Practice Address - Fax:870-414-4949
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2025-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024001361207P00000X
GA79977207P00000X
ARE19128207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine