Provider Demographics
NPI:1336327220
Name:LINTON, DRUENELL ELIA (MD)
Entity Type:Individual
Prefix:
First Name:DRUENELL
Middle Name:ELIA
Last Name:LINTON
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 1:3825 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:AUSTELL
Mailing Address - State:GA
Mailing Address - Zip Code:30106-6831
Mailing Address - Country:US
Mailing Address - Phone:770-941-7741
Mailing Address - Fax:770-941-7196
Practice Address - Street 1:3825 MEDICAL PARK DR
Practice Address - Street 2:SUITE 301
Practice Address - City:AUSTELL
Practice Address - State:GA
Practice Address - Zip Code:30106-6831
Practice Address - Country:US
Practice Address - Phone:770-941-7741
Practice Address - Fax:770-941-7196
Is Sole Proprietor?:No
Enumeration Date:2008-02-04
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA58271207RC0000X
GA058271207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA311640178A,CMedicaid
GA202I061962Medicare PIN