Provider Demographics
NPI:1235290701
Name:AUSTIN, ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:AUSTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:F.
Other - Middle Name:ELIZABETH
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:106 E 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:GA
Mailing Address - Zip Code:30161-3128
Mailing Address - Country:US
Mailing Address - Phone:706-232-8330
Mailing Address - Fax:706-232-8331
Practice Address - Street 1:106 E 5TH AVE
Practice Address - Street 2:
Practice Address - City:ROME
Practice Address - State:GA
Practice Address - Zip Code:30161-3128
Practice Address - Country:US
Practice Address - Phone:706-232-8330
Practice Address - Fax:706-232-8331
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA01178103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA68BBDWDMedicare ID - Type UnspecifiedPSYCHOLOGIST