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General NPI Number Information
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NPI Number | 1568061000
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Entity Type | Organization
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Legal Business Name | ESRPA
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Dates
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Enumeration Date | 10/24/2020
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Last Update Date | 12/22/2020
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Provider Practice Location Address
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Address Line | 1717 BENHILL DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-2595
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Country | US
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Telephone | 770-689-8936
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Fax |
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Provider Business Mailing Address
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Address Line | 1717 BENHILL DR
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City | SNELLVILLE
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State | GA
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Zip | 30078-2595
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PROVIDER
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Name | ELISSA STANTON
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Credential |
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Telephone | 770-689-8936
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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