Provider Demographics
NPI:1104378678
Name:ELLIOTT, ROWENA W (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROWENA
Middle Name:W
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 CLIFTON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-4201
Mailing Address - Country:US
Mailing Address - Phone:404-727-8170
Mailing Address - Fax:
Practice Address - Street 1:7 EXECUTIVE PARK DR NE
Practice Address - Street 2:APT. 1301
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2250
Practice Address - Country:US
Practice Address - Phone:601-597-2787
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-31
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN259680163WG0600X, 363LA2200X
MSR624608163WG0600X
MS901572363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology