MEDICARE: CYNTHIA LAWRENCE ELLIOTT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RR0500X	Rheumatology Physician	025997	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720036957
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LAWRENCE ELLIOTT M.D.

Provider Business Mailing Address
First Line	:	600 PROFESSIONAL DR
Second Line	:	SUITE 260
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30046-8719
Country	:	US
Telephone Number	:	770-822-1090
Fax Number	:	770-513-9735

Provider Business Practice Location Address
First Line	:	600 PROFESSIONAL DR
Second Line	:	SUITE 260
City	:	LAWRENCEVILLE
State	:	GA
Zip	:	30045-7651
Country	:	US
Telephone Number	:	770-822-1090
Fax Number	:	770-513-9735

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	02/18/2011

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