Provider Demographics
NPI:1114279379
Name:ELLIOTT, DAVID (MA PSY)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ELLIOTT
Suffix:
Gender:M
Credentials:MA PSY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3181 BEVIS RD
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:GA
Mailing Address - Zip Code:30217-6423
Mailing Address - Country:US
Mailing Address - Phone:706-594-8896
Mailing Address - Fax:
Practice Address - Street 1:3181 BEVIS RD
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:GA
Practice Address - Zip Code:30217-6423
Practice Address - Country:US
Practice Address - Phone:706-594-8896
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker