MEDICARE: MRS. RHONDA SMITH ELLIOTT PA-C

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	363A00000X	Physician Assistant	103349	NC

General Provider Information

NPI Number	:	1831194984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RHONDA SMITH ELLIOTT PA-C

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	330 JAKE ALEXANDER BLVD W STE 104
Second Line	:
City	:	SALISBURY
State	:	NC
Zip	:	28147-1385
Country	:	US
Telephone Number	:	701-645-0901
Fax Number	:	704-645-0907

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	11/21/2022

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