Healthcare Provider Details

I. General information

NPI: 1194708636
Provider Name (Legal Business Name): STEVEN M ELLIOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2005
Last Update Date: 11/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 COLLIER RD NW STE 4060
ATLANTA GA
30309-1765
US

IV. Provider business mailing address

2865 CHANCELLOR DR SUITE 225
CRESTVIEW HILLS KY
41017-3912
US

V. Phone/Fax

Practice location:
  • Phone: 404-351-6662
  • Fax: 404-351-6030
Mailing address:
  • Phone: 859-341-5400
  • Fax: 859-578-4594

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number60729
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: