Healthcare Provider Details

I. General information

NPI: 1629990304
Provider Name (Legal Business Name): ELIZABETH GRACE ELSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 WHITLOCK AVE SW STE E14
MARIETTA GA
30064-3098
US

IV. Provider business mailing address

445 N SESSIONS ST NW APT 1211
MARIETTA GA
30060-1372
US

V. Phone/Fax

Practice location:
  • Phone: 770-927-7424
  • Fax: 404-480-0784
Mailing address:
  • Phone: 770-871-0441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: