Healthcare Provider Details

I. General information

NPI: 1912991464
Provider Name (Legal Business Name): ELIZABETH P RAMBO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETH RAMBO PA-C

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 04/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 HOSPITAL SOUTH DR STE 300
AUSTELL GA
30106-8116
US

IV. Provider business mailing address

531 ROSELANE ST NW STE 710
MARIETTA GA
30060-6975
US

V. Phone/Fax

Practice location:
  • Phone: 770-944-2830
  • Fax: 678-581-7170
Mailing address:
  • Phone: 678-331-3297
  • Fax: 678-581-7187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number004250
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: