Healthcare Provider Details

I. General information

NPI: 1346235108
Provider Name (Legal Business Name): ELIZABETH WILLIAMS PINKERTON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27 ROCK QUARRY RD
TOCCOA GA
30577-8721
US

IV. Provider business mailing address

27 ROCK QUARRY RD
TOCCOA GA
30577-8721
US

V. Phone/Fax

Practice location:
  • Phone: 706-886-8399
  • Fax: 866-200-4254
Mailing address:
  • Phone: 706-886-8399
  • Fax: 866-200-4254

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number033876
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00471303A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: