MEDICARE: DR. ELIZABETH C VEVERA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	041990	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114943388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH C VEVERA M.D.

Provider Business Mailing Address
First Line	:	1505 NORTHSIDE BLVD
Second Line	:	STE 4400
City	:	CUMMING
State	:	GA
Zip	:	30041-7623
Country	:	US
Telephone Number	:	678-513-8800
Fax Number	:	678-513-8500

Provider Business Practice Location Address
First Line	:	1505 NORTHSIDE BLVD
Second Line	:	STE 4400
City	:	CUMMING
State	:	GA
Zip	:	30041-7623
Country	:	US
Telephone Number	:	678-513-8800
Fax Number	:	678-513-8500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2006
Last Update Date	:	10/15/2020

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