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General NPI Number Information
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NPI Number | 1679787410
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Entity Type | Organization
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Legal Business Name | ELITE MEDICAL PHYSICIANS PC
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 06/25/2010
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Provider Practice Location Address
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Address Line | 2892 MOUNTAIN INDUSTRIAL BLVD
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City | TUCKER
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State | GA
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Zip | 30084-3014
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Country | US
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Telephone | 678-534-0452
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Fax | 678-534-1534
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Provider Business Mailing Address
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Address Line | 2892 MOUNTAIN INDUSTRIAL BLVD P.O. BOX 201
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City | TUCKER
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State | GA
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Zip | 30084-3014
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Country | US
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Telephone | 678-534-0452
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Fax | 678-534-1534
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. LOUISE A BROWN
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Credential |
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Telephone | 678-534-0452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 038076
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License Number State | GA
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