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General NPI Number Information
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NPI Number | 1902980246
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Entity Type | Individual
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Provider Name | KIRSTY J ELWELL PA-C
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Gender | Female
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 05/24/2012
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Provider Practice Location Address
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Address Line | 2001 ANTIOCH RD
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City | DALTON
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State | GA
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Zip | 30721-4622
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Country | US
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Telephone | 706-275-7600
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Fax | 706-275-0013
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Provider Business Mailing Address
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Address Line | 2001 ANTIOCH RD
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City | DALTON
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State | GA
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Zip | 30721-4622
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Country | US
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Telephone | 706-275-7600
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Fax | 706-275-0013
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | GA4447
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1519
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License Number State | TN
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