Healthcare Provider Details

I. General information

NPI: 1316516875
Provider Name (Legal Business Name): ELANA GEBHARD-KOENIGSTEIN NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2021
Last Update Date: 10/29/2022
Certification Date: 10/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

1836 MEMORIAL DR SE APT 303
ATLANTA GA
30317-2127
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-4500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN275703
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: