Healthcare Provider Details

I. General information

NPI: 1992781132
Provider Name (Legal Business Name): JOHN FREDERICK ELDER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 02/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 PRINCE AVE
ATHENS GA
30606-2797
US

IV. Provider business mailing address

700 SUNSET DR SUITE 601
ATHENS GA
30606-2293
US

V. Phone/Fax

Practice location:
  • Phone: 706-475-7000
  • Fax: 706-475-6676
Mailing address:
  • Phone: 706-548-4754
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number020098
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: