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General NPI Number Information
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NPI Number | 1396270294
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Entity Type | Organization
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Legal Business Name | ELITE PRIME HEALTH
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Dates
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Enumeration Date | 04/27/2017
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Last Update Date | 04/27/2017
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Provider Practice Location Address
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Address Line | 3270 WALTON RIVERWOOD LN SE 3056
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City | ATLANTA
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State | GA
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Zip | 30339-3561
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Country | US
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Telephone | 901-573-7374
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Fax |
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Provider Business Mailing Address
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Address Line | 3270 WALTON RIVERWOOD LN SE 3056
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City | ATLANTA
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State | GA
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Zip | 30339-3561
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Country | US
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Telephone | 901-573-7374
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MALINDA CONRAD
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Credential | FNP-BC
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Telephone | 901-573-7374
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 13630
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License Number State | TN
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