Provider Demographics
NPI:1356836449
Name:ELISME ANAXE, ERLANGE
Entity Type:Individual
Prefix:MS
First Name:ERLANGE
Middle Name:
Last Name:ELISME ANAXE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ERLANGE
Other - Middle Name:
Other - Last Name:ELISME
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3521 BROCKENHURST DR
Mailing Address - Street 2:
Mailing Address - City:BUFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30519-4697
Mailing Address - Country:US
Mailing Address - Phone:404-441-1730
Mailing Address - Fax:
Practice Address - Street 1:3521 BROCKENHURST DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4697
Practice Address - Country:US
Practice Address - Phone:404-441-1730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-30
Last Update Date:2018-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator