MEDICARE: ELISA DRUSKY PA-C

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	363AM0700X	Medical Physician Assistant	50.005234RX	OH
2	363AM0700X	Medical Physician Assistant	9189	GA

General Provider Information

NPI Number	:	1386156503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELISA DRUSKY PA-C

Provider Business Mailing Address
First Line	:	711 CANTON RD NE STE 300
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-8949
Country	:	US
Telephone Number	:	678-741-5000
Fax Number	:	678-819-4280

Provider Business Practice Location Address
First Line	:	711 CANTON RD NE STE 300
Second Line	:
City	:	MARIETTA
State	:	GA
Zip	:	30060-8949
Country	:	US
Telephone Number	:	678-741-5000
Fax Number	:	678-819-4280

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

Provider Enumeration Date	:	10/27/2017
Last Update Date	:	03/11/2019

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