Healthcare Provider Details

I. General information

NPI: 1689789703
Provider Name (Legal Business Name): NANCY ELWOOD, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 06/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1811 EDWINA DR
VIDALIA GA
30474-8963
US

IV. Provider business mailing address

1811 EDWINA DR
VIDALIA GA
30474-8963
US

V. Phone/Fax

Practice location:
  • Phone: 912-538-9774
  • Fax: 912-608-8037
Mailing address:
  • Phone: 912-538-9774
  • Fax: 912-608-8037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number053140
License Number StateGA

VIII. Authorized Official

Name: MS. NANCY SUE ELWOOD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 912-538-9774