Healthcare Provider Details

I. General information

NPI: 1497074298
Provider Name (Legal Business Name): LASHAUN DENISE ELLIOTT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 08/14/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4651 ROSWELL RD STE I803
ATLANTA GA
30342-3023
US

IV. Provider business mailing address

3359 BRIDLE RUN TRL NW
MARIETTA GA
30064-1785
US

V. Phone/Fax

Practice location:
  • Phone: 678-819-7777
  • Fax: 678-845-5855
Mailing address:
  • Phone: 917-500-4799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number68404
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code2083A0300X
TaxonomyAddiction Medicine (Preventive Medicine) Physician
License Number68404
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number68404
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number68404
License Number StateGA
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number68404
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number261986
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: