Healthcare Provider Details

I. General information

NPI: 1841812849
Provider Name (Legal Business Name): ELIZABETH KRISTINE GINELLI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2020
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 15TH ST # BB-4515
AUGUSTA GA
30912-0006
US

IV. Provider business mailing address

1120 15TH ST # BB-4515
AUGUSTA GA
30912-0006
US

V. Phone/Fax

Practice location:
  • Phone: 706-721-7702
  • Fax: 706-721-3239
Mailing address:
  • Phone: 706-721-7702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number114644
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: