Provider Demographics
NPI:1346920725
Name:SKARDA, ELIZABETH GAIL
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:GAIL
Last Name:SKARDA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3687 COCHRAN RD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30506-3636
Mailing Address - Country:US
Mailing Address - Phone:404-477-8898
Mailing Address - Fax:
Practice Address - Street 1:1220 SHERWOOD PARK DR NE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3445
Practice Address - Country:US
Practice Address - Phone:470-691-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician