Healthcare Provider Details

I. General information

NPI: 1538588553
Provider Name (Legal Business Name): LUJAYN ELKAIALI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 03/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3455 OLD ALABAMA RD
ALPHARETTA GA
30022-5526
US

IV. Provider business mailing address

3455 OLD ALABAMA RD
ALPHARETTA GA
30022-5526
US

V. Phone/Fax

Practice location:
  • Phone: 770-826-1431
  • Fax:
Mailing address:
  • Phone: 770-826-1431
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDNES000432.
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: