Provider Demographics
NPI:1063674612
Name:DUGGAN, ELIZABETH WATSON (MD)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:WATSON
Last Name:DUGGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1364 CLIFTON RD NE
Mailing Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY - B355
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-1104
Mailing Address - Country:US
Mailing Address - Phone:404-778-0695
Mailing Address - Fax:
Practice Address - Street 1:1364 CLIFTON RD NE
Practice Address - Street 2:DEPARTMENT OF ANESTHESIOLOGY - B355
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-1104
Practice Address - Country:US
Practice Address - Phone:404-778-0695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT192243207L00000X
PAMD443044207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0269514Medicaid
PA102622540Medicaid
PA102622540Medicaid