Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 047738 | GA |
Y | 207VG0400X | Gynecologist | 047738 | GA |
NPI | 1073544953 |
---|---|
Provider Name | Dr. Jennifer L Elliott |
First Address | Alpharetta, GA 30005-4381 |
Second Address | Alpharetta, GA 30005-4381 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/07/2006 |
Last Update Date | 28/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000942037A | (05) | GA |
H56474 | (02) | GA |