Provider Demographics
NPI:1235433418
Name:ELITE CARE INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:ELITE CARE INTERNAL MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:PRIYA
Authorized Official - Middle Name:CHOYAN
Authorized Official - Last Name:PALLIYIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-667-0810
Mailing Address - Street 1:1240 UPPER HEMBREE RD
Mailing Address - Street 2:STE D
Mailing Address - City:ROSWELL
Mailing Address - State:GA
Mailing Address - Zip Code:30076-0914
Mailing Address - Country:US
Mailing Address - Phone:770-667-0810
Mailing Address - Fax:
Practice Address - Street 1:1240 UPPER HEMBREE RD
Practice Address - Street 2:STE D
Practice Address - City:ROSWELL
Practice Address - State:GA
Practice Address - Zip Code:30076-0914
Practice Address - Country:US
Practice Address - Phone:770-667-0810
Practice Address - Fax:678-288-7942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-03
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA053869261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA385314069AMedicaid
GA202G112773Medicare PIN
GA385314069AMedicaid