Healthcare Provider Details

I. General information

NPI: 1699532028
Provider Name (Legal Business Name): ELAMENT VIRTUAL SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 03/04/2024
Certification Date: 03/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 INTERSTATE NORTH CIR SE STE 200
ATLANTA GA
30339-2384
US

IV. Provider business mailing address

3100 INTERSTATE NORTH CIR SE STE 200
ATLANTA GA
30339-2384
US

V. Phone/Fax

Practice location:
  • Phone: 470-608-2286
  • Fax:
Mailing address:
  • Phone: 470-608-2286
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: LATOYA ELAM
Title or Position: IBO
Credential:
Phone: 470-608-2286