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General NPI Number Information
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NPI Number | 1508437211
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Entity Type | Individual
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Provider Name | ELISABETH AUSTIN UNDERWOOD
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Gender | Female
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Dates
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Enumeration Date | 07/03/2021
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Last Update Date | 05/26/2022
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Provider Practice Location Address
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Address Line | 1000 JOHNSON FY RD NE
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City | ATLANTA
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State | GA
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Zip | 30342-1606
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Country | US
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Telephone | 404-851-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 417 SAINT CATHERINES CT NW
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City | MARIETTA
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State | GA
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Zip | 30064-1430
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Country | US
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Telephone | 770-361-7858
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN249617
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 137811
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License Number State | GA
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