Healthcare Provider Details

I. General information

NPI: 1962164954
Provider Name (Legal Business Name): ELIZABETH PEYTON ALBERTSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2021
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 JOHN MADDOX DR NW STE 100
ROME GA
30165-3000
US

IV. Provider business mailing address

PO BOX 12938 C/O CLINIC MANAGEMENT
CALHOUN GA
30703
US

V. Phone/Fax

Practice location:
  • Phone: 706-528-9060
  • Fax: 706-290-2399
Mailing address:
  • Phone: 706-602-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number10705
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: