Healthcare Provider Details

I. General information

NPI: 1730863788
Provider Name (Legal Business Name): ELIZABETH MCKENZIE GROFF FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 EATONTON RD
MADISON GA
30650-4627
US

IV. Provider business mailing address

3320 OLD JEFFERSON RD BLDG 800
ATHENS GA
30607-1400
US

V. Phone/Fax

Practice location:
  • Phone: 706-752-0322
  • Fax:
Mailing address:
  • Phone: 706-353-2990
  • Fax: 706-353-2992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP286161
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-NP286161
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: