Provider Demographics
NPI:1093728404
Name:STRONG, BETTY ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:BETTY
Middle Name:ELIZABETH
Last Name:STRONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1203 CLEVELAND AVE
Mailing Address - Street 2:SUITE 1-A
Mailing Address - City:EAST POINT
Mailing Address - State:GA
Mailing Address - Zip Code:30344-3417
Mailing Address - Country:US
Mailing Address - Phone:404-835-2891
Mailing Address - Fax:404-835-2899
Practice Address - Street 1:1203 CLEVELAND AVE
Practice Address - Street 2:SUITE 1-A
Practice Address - City:EAST POINT
Practice Address - State:GA
Practice Address - Zip Code:30344-3417
Practice Address - Country:US
Practice Address - Phone:404-835-2891
Practice Address - Fax:404-835-2899
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA39485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAG34211Medicare UPIN