Healthcare Provider Details

I. General information

NPI: 1689870552
Provider Name (Legal Business Name): GINGER DALE ELKIN PTA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 N OAK ST SUITE A
VALDOSTA GA
31602-1772
US

IV. Provider business mailing address

316 BULLARD RD
ADEL GA
31620-6359
US

V. Phone/Fax

Practice location:
  • Phone: 229-249-9600
  • Fax: 229-249-9976
Mailing address:
  • Phone: 229-896-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License NumberPTA001585
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: