Provider Demographics
NPI:1033126578
Name:SERGILE, ELIZABETH T (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:T
Last Name:SERGILE
Suffix:
Gender:F
Credentials:MD
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Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3400 OLD MILTON PKWY
Mailing Address - Street 2:STE A130
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-3707
Mailing Address - Country:US
Mailing Address - Phone:770-664-8898
Mailing Address - Fax:770-772-4377
Practice Address - Street 1:3400 OLD MILTON PKWY
Practice Address - Street 2:STE A130
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3707
Practice Address - Country:US
Practice Address - Phone:770-664-8898
Practice Address - Fax:770-772-4377
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2020-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GA051739207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003149910AMedicaid
GA003149910AMedicaid
NC90016GMedicare UPIN