Healthcare Provider Details

I. General information

NPI: 1821379033
Provider Name (Legal Business Name): ELIZABETH ANN STARGELL NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1365 CLIFTON RD NE OFFICE A4330
ATLANTA GA
30322-1013
US

IV. Provider business mailing address

127 MARTIN LUTHER KING JR CT
LAGRANGE GA
30241-3657
US

V. Phone/Fax

Practice location:
  • Phone: 404-778-6382
  • Fax: 404-778-5495
Mailing address:
  • Phone: 706-594-2955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN160119
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: