Healthcare Provider Details

I. General information

NPI: 1306237706
Provider Name (Legal Business Name): ELMWOOD PARK ANESTHESIA CONSULTANTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2015
Last Update Date: 06/17/2025
Certification Date: 06/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 JUNIPER ST NE
ATLANTA GA
30308
US

IV. Provider business mailing address

950 EAGLES LANDING PKWY 116
STOCKBRIDGE GA
30281
US

V. Phone/Fax

Practice location:
  • Phone: 404-873-2871
  • Fax:
Mailing address:
  • Phone: 313-587-3369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY EVANS
Title or Position: OWNER
Credential:
Phone: 313-587-3369