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General NPI Number Information
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NPI Number | 1528689841
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Entity Type | Organization
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Legal Business Name | ELYSIUM HEALTH AND WELLNESS
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Dates
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Enumeration Date | 04/27/2020
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Last Update Date | 04/27/2020
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Provider Practice Location Address
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Address Line | 5555 PEACHTREE DUNWOODY RD STE 201
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City | ATLANTA
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State | GA
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Zip | 30342-1711
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Country | US
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Telephone | --
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Fax |
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Provider Business Mailing Address
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Address Line | 5555 PEACHTREE DUNWOODY RD STE 201
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City | ATLANTA
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State | GA
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Zip | 30342-1711
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Country | US
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Telephone | 470-663-6622
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. TRENTON C ELLIOTT
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Credential | MD
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Telephone | 470-663-6622
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State |
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