Healthcare Provider Details

I. General information

NPI: 1568910461
Provider Name (Legal Business Name): EMILY ELSWICK PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E VILLANOW ST
LA FAYETTE GA
30728-2618
US

IV. Provider business mailing address

1949 GUNBARREL RD SUITE 230
CHATTANOOGA TN
37421-3188
US

V. Phone/Fax

Practice location:
  • Phone: 706-638-1606
  • Fax: 423-493-6457
Mailing address:
  • Phone: 423-495-4349
  • Fax: 423-495-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8055
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: