Provider Demographics
NPI:1073544953
Name:ELLIOTT, JENNIFER L (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:L
Last Name:ELLIOTT
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 1:3180 NORTH POINT PKWY
Mailing Address - Street 2:BLDG 200 SUITE 205
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-4381
Mailing Address - Country:US
Mailing Address - Phone:707-777-4933
Mailing Address - Fax:707-777-4934
Practice Address - Street 1:3180 N POINT PKWY STE 205
Practice Address - Street 2:
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-4381
Practice Address - Country:US
Practice Address - Phone:770-777-4933
Practice Address - Fax:770-777-4934
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA047738207V00000X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000942037AMedicaid
GA000942037AMedicaid
16BBBQQMedicare PIN