Healthcare Provider Details

I. General information

NPI: 1780170548
Provider Name (Legal Business Name): ELIZABETH JANE HERMAN MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/05/2018
Last Update Date: 07/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 BUFORD HWY
CHAMBLEE GA
30341-3717
US

IV. Provider business mailing address

1262 WILDCLIFF PKWY NE
ATLANTA GA
30329-3476
US

V. Phone/Fax

Practice location:
  • Phone: 770-488-3711
  • Fax:
Mailing address:
  • Phone: 404-790-4823
  • Fax: 404-790-1540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38012
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: