MEDICARE: DR. ELLIOT PAUL ROYSTON 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	207R00000X	Internal Medicine Physician	039454	GA

General Provider Information

NPI Number	:	1962411207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELLIOT PAUL ROYSTON M.D.

Provider Business Mailing Address
First Line	:	2785 LAWRENCEVILLE HWY STE 210
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-2515
Country	:	US
Telephone Number	:	770-939-5130
Fax Number	:	770-908-8619

Provider Business Practice Location Address
First Line	:	2785 LAWRENCEVILLE HWY STE 210
Second Line	:
City	:	DECATUR
State	:	GA
Zip	:	30033-2515
Country	:	US
Telephone Number	:	770-939-5130
Fax Number	:	770-908-8619

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

Provider Enumeration Date	:	08/05/2006
Last Update Date	:	03/13/2023

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